Provider Demographics
NPI:1851681050
Name:BYRNE, ELLEN BRIDGET
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:BRIDGET
Last Name:BYRNE
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 1:1080 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3812
Mailing Address - Country:US
Mailing Address - Phone:570-346-5924
Mailing Address - Fax:570-343-8458
Practice Address - Street 1:1080 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3812
Practice Address - Country:US
Practice Address - Phone:570-346-5924
Practice Address - Fax:570-343-8458
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032892L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist