Healthcare Provider Details

I. General information

NPI: 1194724880
Provider Name (Legal Business Name): BUTLER DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST
PORTAGEVILLE MO
63873-1614
US

IV. Provider business mailing address

222 E MAIN ST
PORTAGEVILLE MO
63873-1614
US

V. Phone/Fax

Practice location:
  • Phone: 573-379-5469
  • Fax: 573-379-5459
Mailing address:
  • Phone: 573-379-5469
  • Fax: 573-379-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD RONE III
Title or Position: OWNER
Credential: PHARMD
Phone: 573-379-5469