Provider Demographics
NPI:1053492405
Name:CLINTON BUTLER
Entity Type:Organization
Organization Name:CLINTON BUTLER
Other - Org Name:CLINTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-745-8414
Mailing Address - Street 1:2526 HWY 65 SOUTH
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031
Mailing Address - Country:US
Mailing Address - Phone:501-745-8414
Mailing Address - Fax:501-745-8282
Practice Address - Street 1:2526 HIGHWAY 65 S
Practice Address - Street 2:SUITE 101
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6657
Practice Address - Country:US
Practice Address - Phone:501-745-8414
Practice Address - Fax:501-745-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR12116183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR12116OtherSTATE LICENSE
AR0412116OtherNCPDP