Provider Demographics
NPI:1366727885
Name:PAYNE, AMANDA KAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1176
Mailing Address - Country:US
Mailing Address - Phone:405-234-6678
Mailing Address - Fax:405-260-1643
Practice Address - Street 1:1621 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5020
Practice Address - Country:US
Practice Address - Phone:405-260-1574
Practice Address - Fax:405-260-1643
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist