Healthcare Provider Details

I. General information

NPI: 1033259197
Provider Name (Legal Business Name): V E BUTLER AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S. LAFAYETTE ST COMMUNITYCARE PHARMACY
FORT WAYNE IN
46806-1100
US

IV. Provider business mailing address

2700 S. LAFAYETTE ST COMMUNITYCARE PHARMACY
FORT WAYNE IN
46806-1100
US

V. Phone/Fax

Practice location:
  • Phone: 260-458-9800
  • Fax:
Mailing address:
  • Phone: 260-458-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26017770
License Number StateIN

VIII. Authorized Official

Name: MR. VICTOR EUGENE BUTLER
Title or Position: PHARMACIST AND OWNER
Credential: R.PH., MBA
Phone: 260-458-9800