Provider Demographics
NPI:1356676639
Name:BUTLER, MARK ELLIOT (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ELLIOT
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 TREE RIDGE LN NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8899
Mailing Address - Country:US
Mailing Address - Phone:360-779-7393
Mailing Address - Fax:
Practice Address - Street 1:19475 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7527
Practice Address - Country:US
Practice Address - Phone:360-697-2209
Practice Address - Fax:360-697-5979
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00049872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist