Provider Demographics
NPI:1891197315
Name:BYERS, MICAH
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:BYERS
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 1:23122 SAINT FRANCIS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-9807
Mailing Address - Country:US
Mailing Address - Phone:763-753-0222
Mailing Address - Fax:
Practice Address - Street 1:23122 SAINT FRANCIS BLVD NW
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-9807
Practice Address - Country:US
Practice Address - Phone:763-753-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist