MEDICARE: MICAH BYERS

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	183500000X	Pharmacist	121394	MN

General Provider Information

NPI Number	:	1891197315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAH BYERS

Provider Business Mailing Address
First Line	:	23122 SAINT FRANCIS BLVD NW
Second Line	:
City	:	SAINT FRANCIS
State	:	MN
Zip	:	55070-9807
Country	:	US
Telephone Number	:	763-753-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	23122 SAINT FRANCIS BLVD NW
Second Line	:
City	:	SAINT FRANCIS
State	:	MN
Zip	:	55070-9807
Country	:	US
Telephone Number	:	763-753-0222
Fax Number	:

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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Directions to “ MICAH BYERS ” Practice Location

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