Taite Byerly, PHARM.D.
Individual provider Active NPI Pharmacist · Fredericktown, MO
NPI 1609425933 · NPPES record last updated Sep 9, 2019
Key facts
- NPI
- 1609425933
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2006029421 (MO)
- Practice address
- 1025 Walton Dr
Fredericktown, MO 63645-7235 - Phone
- (573) 783-2663
- Fax
- (573) 783-8003
- NPI assigned
- Sep 9, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006029421 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past |
Accepting new patients | |
| Wal-Mart Stores East, LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2006029421 | MO | Yes |
Addresses
Primary practice location
1025 Walton Dr
Fredericktown, MO 63645-7235
Mailing address
103 Azalea Dr
Fredericktown, MO 63645-1152
Other practice location 1
1025 Walton Dr
Fredericktown, MO 63645-7235
Phone (573) 783-2663
Other providers in Fredericktown, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.