Provider Demographics
NPI:1740947985
Name:BUTH, DANIEL VIBOL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:VIBOL
Last Name:BUTH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:BUTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8319 EDEN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3007
Mailing Address - Country:US
Mailing Address - Phone:804-263-4251
Mailing Address - Fax:
Practice Address - Street 1:11895 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1065
Practice Address - Country:US
Practice Address - Phone:804-360-3268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist