Healthcare Provider Details

I. General information

NPI: 1992183040
Provider Name (Legal Business Name): JESSE I. BUTLER RPH,PHARMD,BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2015
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD
MURFREESBORO TN
37129-1392
US

IV. Provider business mailing address

3400 LEBANON RD
MURFREESBORO TN
37129-1392
US

V. Phone/Fax

Practice location:
  • Phone: 931-801-8129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3153410
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number37358
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: