Provider Demographics
NPI:1427658210
Name:BYRD, TIMOTHY DEWAYNE (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DEWAYNE
Last Name:BYRD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 MOOREBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9783
Mailing Address - Country:US
Mailing Address - Phone:270-992-0548
Mailing Address - Fax:
Practice Address - Street 1:150 WALTON AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6361
Practice Address - Country:US
Practice Address - Phone:270-782-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist