Provider Demographics
NPI:1164707261
Name:BUTLER, BRADLEY (RPH)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 N 28TH DR BLDG E, STE 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-892-5155
Mailing Address - Fax:602-281-7284
Practice Address - Street 1:11221 N 28TH DR BLDG E, STE 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-892-5155
Practice Address - Fax:602-281-7284
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist