Healthcare Provider Details

I. General information

NPI: 1992594873
Provider Name (Legal Business Name): JACOB THOMAS BUTTON CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 COOPER POINT RD NW
OLYMPIA WA
98502-4436
US

IV. Provider business mailing address

300 KENYON ST NW APT N7
OLYMPIA WA
98502-2781
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-8014
  • Fax:
Mailing address:
  • Phone: 360-884-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA61685686
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPT-0015544
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: