Provider Demographics
NPI:1992412720
Name:MOON, BYRON JOHN III (RPH)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:JOHN
Last Name:MOON
Suffix:III
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 1:4072 APPLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-6634
Mailing Address - Country:US
Mailing Address - Phone:814-860-6338
Mailing Address - Fax:
Practice Address - Street 1:4072 APPLEBERRY DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-6634
Practice Address - Country:US
Practice Address - Phone:814-860-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044880L183500000X
PARPI016111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist