Provider Demographics
NPI:1972814234
Name:BUTERBAUGH, TRENT ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:ALLEN
Last Name:BUTERBAUGH
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 1:197 TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-4023
Mailing Address - Country:US
Mailing Address - Phone:724-459-6427
Mailing Address - Fax:
Practice Address - Street 1:197 TRUMAN RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-4023
Practice Address - Country:US
Practice Address - Phone:724-459-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040111L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist