MEDICARE: CLINTON BUTLER

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	183500000X	Pharmacist	AR12116	AR
2	3336C0003X	Community/Retail Pharmacy	AR12116	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AR12116	OTHER	AR	STATE LICENSE
2	0412116	OTHER	AR	NCPDP

General Provider Information

NPI Number	:	1053492405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON BUTLER

Provider Business Mailing Address
First Line	:	2526 HWY 65 SOUTH
Second Line	:	SUITE 101
City	:	CLINTON
State	:	AR
Zip	:	72031
Country	:	US
Telephone Number	:	501-745-8414
Fax Number	:	501-745-8282

Provider Business Practice Location Address
First Line	:	2526 HIGHWAY 65 S
Second Line	:	SUITE 101
City	:	CLINTON
State	:	AR
Zip	:	72031-6657
Country	:	US
Telephone Number	:	501-745-8414
Fax Number	:	501-745-8282

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL BUTLER
Credential	:
Telephone Number	:	501-745-8414

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/28/2019

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Directions to “CLINTON BUTLER ” Practice Location

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