Healthcare Provider Details

I. General information

NPI: 1679243505
Provider Name (Legal Business Name): MATTHEW BUTLER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 TELEGRAPH RD
MIDDLEPORT NY
14105-9638
US

IV. Provider business mailing address

6221 TONAWANDA CREEK RD
LOCKPORT NY
14094-7926
US

V. Phone/Fax

Practice location:
  • Phone: 716-735-3261
  • Fax:
Mailing address:
  • Phone: 518-593-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: