Provider Demographics
NPI:1689320657
Name:BUTCHER, ANDREW RILEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:RILEY
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 1:5015 NORTHERN LIGHTS DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3174
Mailing Address - Country:US
Mailing Address - Phone:406-350-1104
Mailing Address - Fax:
Practice Address - Street 1:5015 NORTHERN LIGHTS DR UNIT C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3174
Practice Address - Country:US
Practice Address - Phone:406-350-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-80104183500000X
COPHA.0023890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist