Individual
BRIAN W BYRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2250 CORONADO ST, IDAHO FALLS, ID 83404-7552
(208) 542-4141
Mailing address
3740 REDWOOD CT, REXBURG, ID 83440-4771
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P9412
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P9412
IDAHO STATE LICENSE
ID
Enumeration date
12/06/2022
Last updated
12/06/2022
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