Provider Demographics
NPI:1346673340
Name:PAYNE, LANITA (RPH)
Entity type:Individual
Prefix:
First Name:LANITA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 BISHOP BLVD SUITE 115
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75275-0001
Mailing Address - Country:US
Mailing Address - Phone:214-768-2149
Mailing Address - Fax:
Practice Address - Street 1:6211 BISHOP BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205
Practice Address - Country:US
Practice Address - Phone:214-768-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist