Provider Demographics
NPI:1730412156
Name:BUTER, JOHN STEPHEN (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
Last Name:BUTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3002
Mailing Address - Country:US
Mailing Address - Phone:704-289-2501
Mailing Address - Fax:704-289-1114
Practice Address - Street 1:396 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4043
Practice Address - Country:US
Practice Address - Phone:704-289-5041
Practice Address - Fax:704-289-9537
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0905504Medicaid