Provider Demographics
NPI:1295014397
Name:BYRD, JENNIFER COOPER
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:COOPER
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FIVE POINTS RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-0916
Mailing Address - Country:US
Mailing Address - Phone:919-734-0888
Mailing Address - Fax:919-734-0899
Practice Address - Street 1:110 FIVE POINTS RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-0916
Practice Address - Country:US
Practice Address - Phone:919-734-0888
Practice Address - Fax:919-734-0899
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist