Provider Demographics
NPI:1871242842
Name:SIBLEY, SCHAYLITE R JR
Entity Type:Individual
Prefix:
First Name:SCHAYLITE
Middle Name:R
Last Name:SIBLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 W HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4122
Mailing Address - Country:US
Mailing Address - Phone:817-641-8209
Mailing Address - Fax:817-641-6740
Practice Address - Street 1:1621 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4122
Practice Address - Country:US
Practice Address - Phone:817-641-8209
Practice Address - Fax:817-641-6740
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist