Provider Demographics
NPI:1720277726
Name:BUTTERFIELD PHARMACY & MEDICAL SUPPLY AT SLW LLC
Entity type:Organization
Organization Name:BUTTERFIELD PHARMACY & MEDICAL SUPPLY AT SLW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-489-3700
Mailing Address - Street 1:1707 NW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:SUITE 166
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2517
Mailing Address - Country:US
Mailing Address - Phone:772-323-2090
Mailing Address - Fax:772-323-2091
Practice Address - Street 1:1707 NW SAINT LUCIE WEST BLVD
Practice Address - Street 2:SUITE 166
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:772-323-2090
Practice Address - Fax:772-323-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X, 3336S0011X
FLPH229763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032241500Medicaid
2010018OtherPK