Provider Demographics
NPI:1962277764
Name:ATCHLEY, SIOBHAN
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:ATCHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0369
Mailing Address - Country:US
Mailing Address - Phone:830-833-4815
Mailing Address - Fax:830-833-5585
Practice Address - Street 1:316 PECAN ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-2607
Practice Address - Country:US
Practice Address - Phone:830-833-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist