Provider Demographics
NPI:1881700862
Name:BUTLER, MELINDA M (RPH)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:M
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1132 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1703
Mailing Address - Country:US
Mailing Address - Phone:503-535-3888
Mailing Address - Fax:503-961-8241
Practice Address - Street 1:1132 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1703
Practice Address - Country:US
Practice Address - Phone:503-535-3888
Practice Address - Fax:503-961-8241
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9034183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist