Healthcare Provider Details

I. General information

NPI: 1023846417
Provider Name (Legal Business Name): SYDNEY ALLYSON BUTLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W MARTIN LUTHER KING JR DR
MILLEDGEVILLE GA
31061-2787
US

IV. Provider business mailing address

300 JULE INGRAM RD NE
MILLEDGEVILLE GA
31061-8958
US

V. Phone/Fax

Practice location:
  • Phone: 478-453-1806
  • Fax:
Mailing address:
  • Phone: 478-251-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH032950
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: