MEDICARE: MR. PAUL JOSEPH BUTASH PHARMACIST

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	RP028899L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP028899L	OTHER		PA STATE LICENSE #

General Provider Information

NPI Number	:	1386657468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL JOSEPH BUTASH PHARMACIST

Provider Business Mailing Address
First Line	:	181 CONSTITUTION AVE
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1222
Country	:	US
Telephone Number	:	570-489-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 GEORGE ST
Second Line	:
City	:	THROOP
State	:	PA
Zip	:	18512-1234
Country	:	US
Telephone Number	:	570-489-2331
Fax Number	:	570-489-4791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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