Provider Demographics
NPI:1861809576
Name:BUTCHER, THERESA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3387 SE AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-1705
Mailing Address - Country:US
Mailing Address - Phone:925-323-0977
Mailing Address - Fax:
Practice Address - Street 1:19245 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7456
Practice Address - Country:US
Practice Address - Phone:360-394-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60467899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist