Healthcare Provider Details

I. General information

NPI: 1043114374
Provider Name (Legal Business Name): DEMETRIS BUTLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11890 HEALING WAY
SILVER SPRING MD
20904-7917
US

IV. Provider business mailing address

3139 LORENZO LN
WOODBINE MD
21797-7501
US

V. Phone/Fax

Practice location:
  • Phone: 240-637-5910
  • Fax:
Mailing address:
  • Phone: 240-637-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11378
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: