Provider Demographics
NPI:1417242058
Name:BUTLER, SHAWNA LEA (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:LEA
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 1:886 W STATE ROAD 436
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3006
Mailing Address - Country:US
Mailing Address - Phone:407-618-0036
Mailing Address - Fax:407-618-0036
Practice Address - Street 1:336 S LOST LAKE LN
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4402
Practice Address - Country:US
Practice Address - Phone:703-635-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31200183500000X
VA0202011538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist