Provider Demographics
NPI:1770945495
Name:BYRD, CHRISTIE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:365 E WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952
Mailing Address - Country:US
Mailing Address - Phone:501-743-1166
Mailing Address - Fax:
Practice Address - Street 1:365 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3168
Practice Address - Country:US
Practice Address - Phone:501-743-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist