Provider Demographics
NPI:1114527736
Name:BYFORD, JOHN BRADLEY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRADLEY
Last Name:BYFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1310
Mailing Address - Country:US
Mailing Address - Phone:405-216-8375
Mailing Address - Fax:405-216-8927
Practice Address - Street 1:1101 NW 164TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1310
Practice Address - Country:US
Practice Address - Phone:405-216-8375
Practice Address - Fax:405-216-8927
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist