Provider Demographics
NPI:1326041336
Name:BUTLER PHARMACY INC
Entity Type:Organization
Organization Name:BUTLER PHARMACY INC
Other - Org Name:BUTLER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-679-4175
Mailing Address - Street 1:11 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1805
Mailing Address - Country:US
Mailing Address - Phone:660-679-4175
Mailing Address - Fax:660-679-6088
Practice Address - Street 1:11 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1805
Practice Address - Country:US
Practice Address - Phone:660-679-4175
Practice Address - Fax:660-679-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0035103336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100438870AMedicaid
MO60074470Medicaid
2613467OtherNCPDP PROVIDER IDENTIFICATION NUMBER