Provider Demographics
NPI:1790440469
Name:BUTLER, DARYLL (RPH)
Entity Type:Individual
Prefix:
First Name:DARYLL
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 N GUINNESS LN APT 202
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-0072
Mailing Address - Country:US
Mailing Address - Phone:307-315-4058
Mailing Address - Fax:
Practice Address - Street 1:43 W PRAIRIE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9854
Practice Address - Country:US
Practice Address - Phone:208-772-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9787333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy