Provider Demographics
NPI:1528622651
Name:BYNUM, JULIE TYANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:TYANN
Last Name:BYNUM
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 1:3706 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-4625
Mailing Address - Country:US
Mailing Address - Phone:325-573-7582
Mailing Address - Fax:
Practice Address - Street 1:3706 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-4625
Practice Address - Country:US
Practice Address - Phone:325-573-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist