Provider Demographics
NPI:1548501794
Name:BUTEYN, KRISTY LOVE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LOVE
Last Name:BUTEYN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ROCK RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-1307
Mailing Address - Country:US
Mailing Address - Phone:920-517-3810
Mailing Address - Fax:
Practice Address - Street 1:904 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1201
Practice Address - Country:US
Practice Address - Phone:920-324-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16389-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist