MEDICARE: V E BUTLER AND ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	26017770	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1529657	OTHER	IN	NABP NUMBER

General Provider Information

NPI Number	:	1033259197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V E BUTLER AND ASSOCIATES PC

Provider Business Mailing Address
First Line	:	2700 S. LAFAYETTE ST
Second Line	:	COMMUNITYCARE PHARMACY
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-1100
Country	:	US
Telephone Number	:	260-458-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 S. LAFAYETTE ST
Second Line	:	COMMUNITYCARE PHARMACY
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-1100
Country	:	US
Telephone Number	:	260-458-9800
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST AND OWNER
Name	:	MR. VICTOR EUGENE BUTLER
Credential	:	R.PH., MBA
Telephone Number	:	260-458-9800

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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