Healthcare Provider Details

I. General information

NPI: 1063413391
Provider Name (Legal Business Name): BETH NICOLE BUTCHER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101B E PIKE ST
JACKSON CENTER OH
45334-6000
US

IV. Provider business mailing address

09220 SCHUMAN RD
WAPAKONETA OH
45895-8472
US

V. Phone/Fax

Practice location:
  • Phone: 937-596-8100
  • Fax: 937-596-8108
Mailing address:
  • Phone: 937-539-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-20805
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: