Provider Demographics
NPI:1811437569
Name:ALLERGY BUTLER, LLC
Entity type:Organization
Organization Name:ALLERGY BUTLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-652-7666
Mailing Address - Street 1:10701 S OZARKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5693
Mailing Address - Country:US
Mailing Address - Phone:801-652-7666
Mailing Address - Fax:
Practice Address - Street 1:623 E FORT UNION BLVD
Practice Address - Street 2:STE 102
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5528
Practice Address - Country:US
Practice Address - Phone:801-652-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10267872-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy