Individual
MS. AMY RAQUEL PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1440 S LEWIS AVE, TULSA, OK 74104-4624
(918) 747-6429
(918) 747-3715
Mailing address
1440 S LEWIS AVE, TULSA, OK 74104-4624
(918) 747-6429
(918) 747-3715
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12039
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12039
STATE BOARD OF PHARMACY
OK
Enumeration date
08/31/2011
Last updated
08/31/2011
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