Provider Demographics
NPI:1740884402
Name:BUTLER, BLAKE J (PHARMD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:J
Last Name:BUTLER
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 1:2525 OAKWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-4410
Mailing Address - Country:US
Mailing Address - Phone:256-536-1666
Mailing Address - Fax:401-406-3480
Practice Address - Street 1:2525 OAKWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-4410
Practice Address - Country:US
Practice Address - Phone:256-536-1666
Practice Address - Fax:401-406-3480
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist