Provider Demographics
NPI:1609967041
Name:ATCHLEY, SHADD WARREN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHADD
Middle Name:WARREN
Last Name:ATCHLEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2210
Mailing Address - Country:US
Mailing Address - Phone:918-477-7882
Mailing Address - Fax:918-477-7763
Practice Address - Street 1:8102 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2210
Practice Address - Country:US
Practice Address - Phone:918-477-7882
Practice Address - Fax:918-477-7763
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist