Healthcare Provider Details

I. General information

NPI: 1740947985
Provider Name (Legal Business Name): DANIEL VIBOL BUTH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAN BUTH PHARMD

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 S LABURNUM AVE
RICHMOND VA
23231-2714
US

IV. Provider business mailing address

4837 CARRIAGE HOMES TER
RICHMOND VA
23294-4385
US

V. Phone/Fax

Practice location:
  • Phone: 804-226-0010
  • Fax: 804-222-3755
Mailing address:
  • Phone: 804-263-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202219976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: