Provider Demographics
NPI:1255764304
Name:BYRD, DUSTAN PHILLIP MCNEIL (PHARMD)
Entity type:Individual
Prefix:
First Name:DUSTAN
Middle Name:PHILLIP MCNEIL
Last Name:BYRD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2781
Mailing Address - Country:US
Mailing Address - Phone:910-739-7072
Mailing Address - Fax:910-739-7825
Practice Address - Street 1:3003 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2781
Practice Address - Country:US
Practice Address - Phone:910-739-7072
Practice Address - Fax:910-739-7825
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist