Provider Demographics
NPI:1184248700
Name:BUTTRAM, TIMOTHY A (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:BUTTRAM
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 1:7765 GALPIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9463
Mailing Address - Country:US
Mailing Address - Phone:952-474-6623
Mailing Address - Fax:952-474-8816
Practice Address - Street 1:7765 GALPIN BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9463
Practice Address - Country:US
Practice Address - Phone:952-474-6623
Practice Address - Fax:952-474-8816
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist