Provider Demographics
NPI:1144822867
Name:BYERLEY, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BYERLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-9318
Mailing Address - Country:US
Mailing Address - Phone:573-436-9193
Mailing Address - Fax:573-438-1501
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-9318
Practice Address - Country:US
Practice Address - Phone:573-436-9193
Practice Address - Fax:573-438-1501
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006008797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist