Provider Demographics
NPI:1699730275
Name:CLINTON BUTLER, LLC
Entity type:Organization
Organization Name:CLINTON BUTLER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-642-2620
Mailing Address - Street 1:2526 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031
Mailing Address - Country:US
Mailing Address - Phone:501-745-8414
Mailing Address - Fax:501-745-8282
Practice Address - Street 1:2526 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-8414
Practice Address - Fax:501-745-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR121163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117162716Medicaid
AR100759407Medicaid
AR0412116OtherNABP