Provider Demographics
NPI:1902058407
Name:PAYNE, MEGAN FRITTS (PHARM D)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:FRITTS
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 1:323 E BOYD ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2105
Mailing Address - Country:US
Mailing Address - Phone:815-973-9148
Mailing Address - Fax:
Practice Address - Street 1:2550 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1941
Practice Address - Country:US
Practice Address - Phone:773-935-9610
Practice Address - Fax:773-935-1418
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist