Provider Demographics
NPI:1245716919
Name:ELLIOTT, SHERYLL LANETTE
Entity type:Individual
Prefix:MS
First Name:SHERYLL
Middle Name:LANETTE
Last Name:ELLIOTT
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 1:2700 CENTRAL FWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-2843
Mailing Address - Country:US
Mailing Address - Phone:940-855-2374
Mailing Address - Fax:940-851-8782
Practice Address - Street 1:2700 CENTRAL FWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-2843
Practice Address - Country:US
Practice Address - Phone:940-855-2374
Practice Address - Fax:940-851-8782
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist