Provider Demographics
NPI:1629580147
Name:COLEMAN BUTLER FT SMITH, LLC
Entity Type:Organization
Organization Name:COLEMAN BUTLER FT SMITH, LLC
Other - Org Name:COLEMAN PHARMACY & MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:479-783-5171
Mailing Address - Street 1:3610 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904-6842
Mailing Address - Country:US
Mailing Address - Phone:479-783-5171
Mailing Address - Fax:479-783-0433
Practice Address - Street 1:3610 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-6842
Practice Address - Country:US
Practice Address - Phone:479-783-5171
Practice Address - Fax:479-783-0433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLEMAN BUTLER FT SMITH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG01760332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier