Provider Demographics
NPI:1366722928
Name:BUTLER, LARRY A (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:A
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 1:600 VILLA ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-6720
Mailing Address - Country:US
Mailing Address - Phone:847-695-7727
Mailing Address - Fax:847-695-7548
Practice Address - Street 1:600 VILLA ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-6720
Practice Address - Country:US
Practice Address - Phone:847-695-7727
Practice Address - Fax:847-695-7548
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051030800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist