Provider Demographics
NPI:1770821860
Name:BUTCHER, KYLE I (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:BUTCHER
Suffix:I
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PLACIDA RD STE C
Mailing Address - Street 2:PUBLIX PHARMACY
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4951
Mailing Address - Country:US
Mailing Address - Phone:941-475-2361
Mailing Address - Fax:
Practice Address - Street 1:1500 PLACIDA RD STE C
Practice Address - Street 2:PUBLIX PHARMACY
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4951
Practice Address - Country:US
Practice Address - Phone:941-475-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS48630OtherPHARMACIST LICENSE