Healthcare Provider Details

I. General information

NPI: 1700774866
Provider Name (Legal Business Name): KYLE JOHN BUTZKE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY DR S
FARGO ND
58103-4940
US

IV. Provider business mailing address

1720 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 701-280-4468
  • Fax: 701-280-4643
Mailing address:
  • Phone: 701-280-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6655
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: