Provider Demographics
NPI:1427351766
Name:BUTCHER, MARY D (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:D
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:D
Other - Last Name:PUTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:N9417 SAM CREST LN
Mailing Address - Street 2:
Mailing Address - City:PICKETT
Mailing Address - State:WI
Mailing Address - Zip Code:54964-9618
Mailing Address - Country:US
Mailing Address - Phone:920-216-9904
Mailing Address - Fax:920-589-2135
Practice Address - Street 1:N9417 SAM CREST LN
Practice Address - Street 2:
Practice Address - City:PICKETT
Practice Address - State:WI
Practice Address - Zip Code:54964-9618
Practice Address - Country:US
Practice Address - Phone:920-216-9904
Practice Address - Fax:920-589-2135
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11514183500000X
FLPS 34536183500000X
HIPH 1849183500000X
IL5302361183500000X
MI5302030095183500000X
VT033.0068159183500000X
WI12460-040183500000X
FLPU6865 CONSULTANT183500000X
TX49611183500000X
NY20056196183500000X
LAPST.019353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist