Individual
TERESA KAY BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
901 S MAIN ST, GROVE, OK 74344-2845
(918) 786-4140
Mailing address
68405 E 306 RD, GROVE, OK 74344-7626
(918) 786-9251
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12107
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287880A
—
OK
Enumeration date
08/09/2010
Last updated
03/23/2016
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