Provider Demographics
NPI:1194972935
Name:BYUN, KELLY C (RPH)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:C
Last Name:BYUN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINTER LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5727
Mailing Address - Country:US
Mailing Address - Phone:718-380-3330
Mailing Address - Fax:718-380-4401
Practice Address - Street 1:16 WINTER LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5727
Practice Address - Country:US
Practice Address - Phone:718-380-3330
Practice Address - Fax:718-380-4401
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist