Provider Demographics
NPI:1134526627
Name:BUTLER, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-6504
Mailing Address - Country:US
Mailing Address - Phone:417-683-4127
Mailing Address - Fax:417-683-6160
Practice Address - Street 1:124 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-6504
Practice Address - Country:US
Practice Address - Phone:417-683-4127
Practice Address - Fax:417-683-6160
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPH045121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist