Provider Demographics
NPI:1174941215
Name:BUTLER, ERICA (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:BACA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:460 HIGHWAY 528
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6633
Mailing Address - Country:US
Mailing Address - Phone:505-771-4877
Mailing Address - Fax:505-771-4878
Practice Address - Street 1:460 HIGHWAY 528
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6633
Practice Address - Country:US
Practice Address - Phone:505-771-4877
Practice Address - Fax:505-771-4878
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist