Provider Demographics
NPI:1083838619
Name:BUTLER, CONNIE MOBLEY (RPH)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MOBLEY
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 LACY RD
Mailing Address - Street 2:
Mailing Address - City:WHIGHAM
Mailing Address - State:GA
Mailing Address - Zip Code:39897-3333
Mailing Address - Country:US
Mailing Address - Phone:229-762-4788
Mailing Address - Fax:
Practice Address - Street 1:133 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-2706
Practice Address - Country:US
Practice Address - Phone:229-377-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist