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1790440469 NPI number — DARYLL BUTLER RPH

NPI Number: 1790440469
Health Care Provider/Practitioner: DARYLL BUTLER RPH

Information about “1790440469” NPI (DARYLL BUTLER RPH) exists in 1790440469 in HTML format HTML  |  1790440469 in plain Text format TXT  |  1790440469 in PDF (Portable Document Format) PDF  |  1790440469 in an XML format XML  formats.

NPI Number : 1790440469 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790440469",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUTLER",
    "FirstName": "DARYLL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3153 N GUINNESS LN APT 202",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POST FALLS",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83854-0072",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-315-4058",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "43 W PRAIRIE SHOPPING CTR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAYDEN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83835-9854",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-772-2774",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/07/2021",
    "LastUpdateDate": "11/07/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "333600000X",
        "TaxonomyName": "Pharmacy",
        "LicenseNumber": "P9787",
        "LicenseNumberStateCode": "ID",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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