Provider Demographics
NPI:1790078327
Name:BYRNE, MARCENA MIKEL II (RPH)
Entity Type:Individual
Prefix:
First Name:MARCENA
Middle Name:MIKEL
Last Name:BYRNE
Suffix:II
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 1:1928 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1231
Mailing Address - Country:US
Mailing Address - Phone:606-248-1052
Mailing Address - Fax:606-248-6598
Practice Address - Street 1:1928 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1231
Practice Address - Country:US
Practice Address - Phone:606-248-1052
Practice Address - Fax:606-248-6598
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist