Provider Demographics
NPI:1154426658
Name:BUTTRAM, MARISA H (RPH)
Entity type:Individual
Prefix:MISS
First Name:MARISA
Middle Name:H
Last Name:BUTTRAM
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 1:2653 VALLEYDALE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2026
Mailing Address - Country:US
Mailing Address - Phone:205-995-4960
Mailing Address - Fax:
Practice Address - Street 1:2653 VALLEYDALE RD
Practice Address - Street 2:WINN-DIXIE PHARMACY 514
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-995-4960
Practice Address - Fax:205-995-4965
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist