Provider Demographics
NPI:1205937588
Name:REID, BYRON L (DPH)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:L
Last Name:REID
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 SHRUM CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186-2845
Mailing Address - Country:US
Mailing Address - Phone:615-666-1861
Mailing Address - Fax:615-666-1865
Practice Address - Street 1:2474 SHRUM CEMETERY RD
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-2845
Practice Address - Country:US
Practice Address - Phone:615-666-1861
Practice Address - Fax:615-666-1865
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10191OtherALABAMA STATE BOARD OF PH