Provider Demographics
NPI:1710508940
Name:BIRON, JOHN JOSEPH
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:BIRON
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 1:219 HIGHWAY 62 412
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9593
Mailing Address - Country:US
Mailing Address - Phone:870-994-2152
Mailing Address - Fax:870-994-2352
Practice Address - Street 1:219 HIGHWAY 62 412
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9593
Practice Address - Country:US
Practice Address - Phone:870-994-2152
Practice Address - Fax:870-994-2352
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD64841835P2201X
ARPD064841835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care