Most Relevant Information
Provider Data
| NPI Number: | 1003463712 |
| Provider Name: | PATRICIA DIANNE SHACKELFORD |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 26982 |
Most Important Dates
| Enumeration Date: | 08/19/2019 |
| Last Updated: | 08/19/2019 |
Provider Practice Location
11937 US HIGHWAY 271
TYLER
TX
757083154
Practice Location Phone/Fax
| Phone: | 9038777088 |
| Fax: | 9038777006 |
Provider Mailing Location
11937 US HIGHWAY 271
TYLER
TX
757083154
Provider Mailing Phone/Fax
| Phone: | 9038777088 |
| Fax: | 9038777006 |