Provider Demographics
NPI:1194724880
Name:BUTLER DRUG STORE INC
Entity type:Organization
Organization Name:BUTLER DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RONE
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:573-379-5469
Mailing Address - Street 1:222 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63873-1614
Mailing Address - Country:US
Mailing Address - Phone:573-379-5469
Mailing Address - Fax:573-379-5459
Practice Address - Street 1:222 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTAGEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63873-1614
Practice Address - Country:US
Practice Address - Phone:573-379-5469
Practice Address - Fax:573-379-5459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUTLER DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-15
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600201404Medicaid
MO600201404Medicaid