Provider Demographics
NPI:1124433008
Name:BYFORD, CORINA (PHARMD)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:BYFORD
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 1:195 BLUEBELL CIR
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:KY
Mailing Address - Zip Code:42076-9116
Mailing Address - Country:US
Mailing Address - Phone:270-436-5345
Mailing Address - Fax:
Practice Address - Street 1:679 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:270-825-1541
Practice Address - Fax:270-825-1685
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013213183500000X
AZS019393183500000X
IL289842183500000X
LA020038183500000X
TN36422183500000X
VA0202211358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist