Provider Demographics
NPI:1760293401
Name:PAYNE, HUNTER EARLE (PHARMD)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:EARLE
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 SAN PABLO AVE APT 628
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1892
Mailing Address - Country:US
Mailing Address - Phone:951-218-0454
Mailing Address - Fax:
Practice Address - Street 1:6045 GIANT RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-2388
Practice Address - Country:US
Practice Address - Phone:951-218-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist