Provider Demographics
NPI:1639460140
Name:BYRNE, COLLEEN R (RPH)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:R
Last Name:BYRNE
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 1:1759 GOUCHER ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1101
Mailing Address - Country:US
Mailing Address - Phone:814-255-6601
Mailing Address - Fax:814-254-1797
Practice Address - Street 1:1759 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1101
Practice Address - Country:US
Practice Address - Phone:814-255-6601
Practice Address - Fax:814-254-1797
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038694R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist