Provider Demographics
NPI:1912594508
Name:ADCOCK, SHERILYN ANN
Entity Type:Individual
Prefix:
First Name:SHERILYN
Middle Name:ANN
Last Name:ADCOCK
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 1:4001 N US HIGHWAY 183
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-3144
Mailing Address - Country:US
Mailing Address - Phone:512-585-4323
Mailing Address - Fax:
Practice Address - Street 1:4001 N US HIGHWAY 183
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-3144
Practice Address - Country:US
Practice Address - Phone:512-585-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19592333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19592OtherTX STATE BOARD OF PHARMACY