MEDICARE: JOCQUELINE BUTLER PHARM.D.

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	2007021863	MO

General Provider Information

NPI Number	:	1861789836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCQUELINE BUTLER PHARM.D.

Provider Business Mailing Address
First Line	:	5201 N BELT HWY
Second Line	:	STE H, T-1977
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1553
Country	:	US
Telephone Number	:	816-671-0822
Fax Number	:	816-671-0822

Provider Business Practice Location Address
First Line	:	5201 N BELT HWY
Second Line	:	STE H, T-1977
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1553
Country	:	US
Telephone Number	:	816-671-0822
Fax Number	:	816-671-0822

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

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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