MEDICARE: ALLERGY BUTLER, LLC

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	3336C0003X	Community/Retail Pharmacy	10267872-1703	UT

General Provider Information

NPI Number	:	1811437569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY BUTLER, LLC

Provider Business Mailing Address
First Line	:	10701 S OZARKS DR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5693
Country	:	US
Telephone Number	:	801-652-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 E FORT UNION BLVD
Second Line	:	STE 102
City	:	MIDVALE
State	:	UT
Zip	:	84047-5528
Country	:	US
Telephone Number	:	801-652-7666
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. EDWARD LOOMIS
Credential	:
Telephone Number	:	801-652-7666

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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