Provider Demographics
NPI:1801203468
Name:BUTT, MICAH BUTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:BUTT
Last Name:BUTT
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 1:4816 NW BETHANY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9254
Mailing Address - Country:US
Mailing Address - Phone:503-439-9014
Mailing Address - Fax:
Practice Address - Street 1:4816 NW BETHANY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-9254
Practice Address - Country:US
Practice Address - Phone:503-439-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist