Provider Demographics
NPI:1558676718
Name:SISLEY, STEPHANIE LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SISLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 GANYMEDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-5135
Mailing Address - Country:US
Mailing Address - Phone:512-791-8852
Mailing Address - Fax:512-528-0400
Practice Address - Street 1:2800 E WHITESTONE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7273
Practice Address - Country:US
Practice Address - Phone:512-528-0251
Practice Address - Fax:512-528-0400
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist