Provider Demographics
NPI:1871149542
Name:PAYNE, CASSANDRA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LYNN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 CONESTOGA PKWY LOT 1
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6666
Mailing Address - Country:US
Mailing Address - Phone:502-281-5006
Mailing Address - Fax:
Practice Address - Street 1:545 CONESTOGA PKWY LOT 1
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6666
Practice Address - Country:US
Practice Address - Phone:502-281-5006
Practice Address - Fax:502-281-5013
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY020236OtherPHARMACY LICENSE