1679019475 NPI number — MEDCON HEALTHCARE SERVICES, INC

Table of content: DAVID RICHARD BUTLER RPH (NPI 1922391978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679019475 NPI number — MEDCON HEALTHCARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDCON HEALTHCARE SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679019475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 SW 115TH AVE APT C10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33174-1058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-647-3716
Provider Business Mailing Address Fax Number:
305-357-9288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 SW 115TH AVE APT C10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33174-1058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-647-3716
Provider Business Practice Location Address Fax Number:
305-357-9288
Provider Enumeration Date:
01/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PINA
Authorized Official First Name:
ALEJANDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-647-3716

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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