Coleman Butler Ft Smith LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR10908 Issued in AR

Legal business name

COLEMAN BUTLER FT SMITH LLC

Doing business as

Coleman Pharmacy

Practice address

3610 Grand Ave
Fort Smith, AR 72904-6842

Phone

(479) 783-5171

Fax

(479) 783-0433

NPI assigned

Oct 10, 2005

Last updated

Mar 14, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael David Butler, PHARMD

Title

President

Phone

(479) 783-5171

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Coleman Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in AR3 enrollments

Enrollment records 3

Tax ID family

Coleman Butler Ft Smith LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Coleman Butler Ft Smith LLC

  • Long Term Care Pharmacy
  • Fort Smith, AR
  • NPI 1134809742
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552521600000",
    "number": "1407844855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 GRAND AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729046842",
            "telephone_number": "479-783-5171",
            "fax_number": "479-783-0433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 GRAND AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729046842",
            "telephone_number": "479-783-5171",
            "fax_number": "479-783-0433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLEMAN BUTLER FT SMITH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2019-03-14",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-783-5171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR10908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100228407",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100239790A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1994117",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coleman Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cole J. Johnson DDS PA
• Amanda L Cole, AGACNP-BC
• Kelsey Ann Cole, DNP
• Michael S Cole, MD
• Coleman Butler Ft Smith LLC
• Coleman Butler Ft Smith, LLC (Coleman Pharmacy & Medical)
• Christopher M Coleman, MD
• Jessica Coleman
• Michael D Coleman Sr., MD
• Ryan Brett Coleman, M.D.

• Community/Retail Pharmacy in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.