Healthcare Provider Details

I. General information

NPI: 1326041336
Provider Name (Legal Business Name): BUTLER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S ORANGE ST
BUTLER MO
64730-1805
US

IV. Provider business mailing address

11 S ORANGE ST
BUTLER MO
64730-1805
US

V. Phone/Fax

Practice location:
  • Phone: 660-679-4175
  • Fax: 660-679-6088
Mailing address:
  • Phone: 660-679-4175
  • Fax: 660-679-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number003510
License Number StateMO

VIII. Authorized Official

Name: DAVE CHILDERS
Title or Position: PRESIDENT/CEO/OWNER
Credential:
Phone: 660-679-4175