Provider Demographics
NPI:1396880142
Name:BUTTRAM, J. LANE IV (PHARMD)
Entity type:Individual
Prefix:DR
First Name:J. LANE
Middle Name:
Last Name:BUTTRAM
Suffix:IV
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 1:915 ALTAMAHA ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3203
Mailing Address - Country:US
Mailing Address - Phone:423-227-2822
Mailing Address - Fax:
Practice Address - Street 1:2337 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3257
Practice Address - Country:US
Practice Address - Phone:423-698-8006
Practice Address - Fax:423-698-8007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist