Healthcare Provider Details

I. General information

NPI: 1831472174
Provider Name (Legal Business Name): KAR-KIT BUTT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MAIN ST
WALNUT CREEK CA
94597-2035
US

IV. Provider business mailing address

412 BRIDLE CT
SAN RAMON CA
94582-5950
US

V. Phone/Fax

Practice location:
  • Phone: 925-933-0307
  • Fax:
Mailing address:
  • Phone: 925-828-6593
  • Fax: 925-828-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: