Provider Demographics
NPI:1952649527
Name:MAGEDANZ, BYRON JUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:JUSTIN
Last Name:MAGEDANZ
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Gender:M
Credentials:PHARMD
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Mailing Address - Street 1:2025 N MOUNT JULIET RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3933
Mailing Address - Country:US
Mailing Address - Phone:615-288-4037
Mailing Address - Fax:615-288-4061
Practice Address - Street 1:2025 N MOUNT JULIET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3933
Practice Address - Country:US
Practice Address - Phone:615-288-4037
Practice Address - Fax:615-288-4061
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2016-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN40560183500000X
KYI10186390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes183500000XPharmacy Service ProvidersPharmacist