Provider Demographics
NPI:1962739409
Name:SHIRLEY, BILLY DALE (RPH)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:DALE
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5425
Mailing Address - Country:US
Mailing Address - Phone:903-234-9509
Mailing Address - Fax:903-234-9419
Practice Address - Street 1:511 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5425
Practice Address - Country:US
Practice Address - Phone:903-234-9509
Practice Address - Fax:903-234-9419
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist