MEDICARE: BUTLER PHARMACY INC

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	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	003510	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2613467	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1326041336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTLER PHARMACY INC

Provider Business Mailing Address
First Line	:	11 S ORANGE ST
Second Line	:
City	:	BUTLER
State	:	MO
Zip	:	64730-1805
Country	:	US
Telephone Number	:	660-679-4175
Fax Number	:	660-679-6088

Provider Business Practice Location Address
First Line	:	11 S ORANGE ST
Second Line	:
City	:	BUTLER
State	:	MO
Zip	:	64730-1805
Country	:	US
Telephone Number	:	660-679-4175
Fax Number	:	660-679-6088

Authorized Official
Title or Position	:	PRESIDENT/CEO/OWNER
Name	:	DAVE CHILDERS
Credential	:
Telephone Number	:	660-679-4175

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/13/2013

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Directions to “BUTLER PHARMACY INC ” Practice Location

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