Provider Demographics
NPI:1669798088
Name:BUTTKE, JASON H (RPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:H
Last Name:BUTTKE
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 1:157 E WAUSHARA ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-9717
Mailing Address - Country:US
Mailing Address - Phone:920-290-0656
Mailing Address - Fax:
Practice Address - Street 1:1203 W FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9289
Practice Address - Country:US
Practice Address - Phone:920-748-6005
Practice Address - Fax:920-361-1582
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist