Provider Demographics
NPI:1063413391
Name:BUTCHER, BETH NICOLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:NICOLE
Last Name:BUTCHER
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:09220 SCHUMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-8472
Mailing Address - Country:US
Mailing Address - Phone:937-539-6600
Mailing Address - Fax:
Practice Address - Street 1:101B E PIKE ST
Practice Address - Street 2:
Practice Address - City:JACKSON CENTER
Practice Address - State:OH
Practice Address - Zip Code:45334-6000
Practice Address - Country:US
Practice Address - Phone:937-596-8100
Practice Address - Fax:937-596-8108
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-20805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist