Provider Demographics
NPI:1629640149
Name:BUTLER, JAY P
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:P
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 RIVERFRONT DR APT 1208
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-2236
Mailing Address - Country:US
Mailing Address - Phone:256-466-7510
Mailing Address - Fax:
Practice Address - Street 1:8815 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-4786
Practice Address - Country:US
Practice Address - Phone:501-455-8080
Practice Address - Fax:501-455-8327
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist