Provider Demographics
NPI:1588266423
Name:BUTLER, STEPHENI MICHELE LUCI L'NORA
Entity type:Individual
Prefix:
First Name:STEPHENI
Middle Name:MICHELE LUCI L'NORA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BEA DOT WAY APT A
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-7043
Mailing Address - Country:US
Mailing Address - Phone:912-618-1375
Mailing Address - Fax:
Practice Address - Street 1:114 E GENERAL SCREVEN WAY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3014
Practice Address - Country:US
Practice Address - Phone:912-877-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist