Provider Demographics
NPI:1457520058
Name:BYRNE, THERESA C (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:C
Last Name:BYRNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4331
Mailing Address - Country:US
Mailing Address - Phone:516-679-2544
Mailing Address - Fax:516-679-2314
Practice Address - Street 1:3491 MERRICK RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4331
Practice Address - Country:US
Practice Address - Phone:516-679-2544
Practice Address - Fax:516-679-2314
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist