Provider Demographics
NPI:1043816176
Name:HARTLEY, SHELLY
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:HARTLEY
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 1:1523 BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5315
Mailing Address - Country:US
Mailing Address - Phone:971-342-7144
Mailing Address - Fax:
Practice Address - Street 1:1520 E EXCHANGE PKWY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4503
Practice Address - Country:US
Practice Address - Phone:214-547-8671
Practice Address - Fax:214-547-9952
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist