Provider Demographics
NPI:1598193229
Name:BUTCHER, JONATHAN THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THOMAS
Last Name:BUTCHER
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 1:18 INDIAN HEAD RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3701
Mailing Address - Country:US
Mailing Address - Phone:631-544-4530
Mailing Address - Fax:
Practice Address - Street 1:18 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3701
Practice Address - Country:US
Practice Address - Phone:631-544-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist