Healthcare Provider Details

I. General information

NPI: 1598890709
Provider Name (Legal Business Name): MICHAEL H BUTTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WEST 2ND BOX 1030
CLARENDON TX
79226-1030
US

IV. Provider business mailing address

PO BOX 1030
CLARENDON TX
79226-1030
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-3554
  • Fax: 806-874-9287
Mailing address:
  • Phone: 806-874-3554
  • Fax: 806-874-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number10254
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10254
License Number StateTX

VIII. Authorized Official

Name: MICHAEL H BUTTS
Title or Position: OWNER
Credential: RPH
Phone: 806-874-3554