Provider Demographics
NPI:1649900341
Name:DAHLEY, SIOBHAN (CPHT)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:DAHLEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 W STATE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-2125
Mailing Address - Country:US
Mailing Address - Phone:623-698-6474
Mailing Address - Fax:
Practice Address - Street 1:8150 S KYRENE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2115
Practice Address - Country:US
Practice Address - Phone:800-788-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT005220183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician