Provider Demographics
NPI:1932484268
Name:SHLYAKT, ANDREY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ANDREY
Middle Name:
Last Name:SHLYAKT
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 1:2161 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5842
Mailing Address - Country:US
Mailing Address - Phone:432-367-0738
Mailing Address - Fax:
Practice Address - Street 1:1211 N US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4501
Practice Address - Country:US
Practice Address - Phone:830-693-8417
Practice Address - Fax:830-693-6758
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist