MEDICARE: BYRON KENNETH BARNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	PS44591	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS44591	OTHER	FL	PHARMACY LICENSE NUMBER

General Provider Information

NPI Number	:	1588913842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON KENNETH BARNEY

Provider Business Mailing Address
First Line	:	10137 LANCASHIRE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-4367
Country	:	US
Telephone Number	:	904-619-7059
Fax Number	:	904-683-0222

Provider Business Practice Location Address
First Line	:	10137 LANCASHIRE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-4367
Country	:	US
Telephone Number	:	904-619-7059
Fax Number	:	904-683-0222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2012
Last Update Date	:	09/02/2012

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