Healthcare Provider Details

I. General information

NPI: 1679753511
Provider Name (Legal Business Name): JOHN PATRICK BUTLER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 ALLENTOWN BLVD SUITE 101
HARRISBURG PA
17112-4049
US

IV. Provider business mailing address

156 HEMLOCK DR
DALLAS PA
18612-2946
US

V. Phone/Fax

Practice location:
  • Phone: 717-810-1950
  • Fax:
Mailing address:
  • Phone: 570-639-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP037319L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: