Healthcare Provider Details

I. General information

NPI: 1831223379
Provider Name (Legal Business Name): JAMES BUTTS JR RPH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3394 HIGHWAY 434
ANGEL FIRE NM
87710
US

IV. Provider business mailing address

PO BOX E
ANGEL FIRE NM
87710-1004
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-2269
  • Fax: 505-377-6220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001207
License Number StateNM

VIII. Authorized Official

Name: JAMES BUTTS
Title or Position: OWNER AND PHARMACIST IN CHARGE
Credential: RPH
Phone: 505-377-2269