Provider Demographics
NPI:1114274123
Name:BUTLER, KAM MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:KAM
Middle Name:MARIE
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 1:2405 WINGATE CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9267
Mailing Address - Country:US
Mailing Address - Phone:661-664-7912
Mailing Address - Fax:
Practice Address - Street 1:2405 WINGATE CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9267
Practice Address - Country:US
Practice Address - Phone:661-664-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4613014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist