Provider Demographics
NPI:1942733860
Name:BUTLER, THERESA (RPH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:904 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1132
Mailing Address - Country:US
Mailing Address - Phone:206-860-4669
Mailing Address - Fax:206-860-2269
Practice Address - Street 1:904 7TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1132
Practice Address - Country:US
Practice Address - Phone:206-860-4669
Practice Address - Fax:206-860-2269
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016451A1835P2201X
WAPH606325021835P2201X, 183500000X
OH033203471835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care