Provider Demographics
NPI:1255639753
Name:BUTLER, VICKY LYNNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:LYNNE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2528
Mailing Address - Country:US
Mailing Address - Phone:704-664-3122
Mailing Address - Fax:704-664-5596
Practice Address - Street 1:274 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2528
Practice Address - Country:US
Practice Address - Phone:704-664-3122
Practice Address - Fax:704-664-5596
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist