Provider Demographics
NPI:1326540915
Name:BUTLER, DAVID ALLAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLAN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 S WOOD ST
Mailing Address - Street 2:ROOM 164 (MC 886)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:312-413-1422
Mailing Address - Fax:312-996-0379
Practice Address - Street 1:833 S WOOD ST
Practice Address - Street 2:ROOM 164 (MC 886)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605
Practice Address - Country:US
Practice Address - Phone:312-413-1422
Practice Address - Fax:312-996-0379
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60665385183500000X
IL051300659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty