Provider Demographics
NPI:1609327089
Name:BUTLER LONG TERM CARE SOLUTIONS
Entity Type:Organization
Organization Name:BUTLER LONG TERM CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHNNY
Authorized Official - Last Name:BAZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:478-862-5655
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:GA
Mailing Address - Zip Code:31006-0546
Mailing Address - Country:US
Mailing Address - Phone:478-862-5655
Mailing Address - Fax:478-862-2811
Practice Address - Street 1:10 B NORTH POPLAR ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:GA
Practice Address - Zip Code:31006
Practice Address - Country:US
Practice Address - Phone:478-862-5655
Practice Address - Fax:478-862-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0103103336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAFLU372OtherMEDICARE FLU SUBMITTER ID
GA000793295A,B,CMedicaid
GA1212970001Medicare NSC