Healthcare Provider Details

I. General information

NPI: 1629593868
Provider Name (Legal Business Name): PATRICK BRIEN BUTTERS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21230 DEQUINDRE RD
WARREN MI
48091-2279
US

IV. Provider business mailing address

2038 HUNTERS CREEK DR
YPSILANTI MI
48198-9610
US

V. Phone/Fax

Practice location:
  • Phone: 586-880-2483
  • Fax:
Mailing address:
  • Phone: 734-985-8291
  • Fax: 586-759-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302027089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: