Basic Information
| Provider Information | |||||||||
| NPI: | 1558813931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAWISH | ||||||||
| FirstName: | AMAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 186TH PL SE | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980128856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259496768 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 164TH ST SW | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980878515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257413646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2016 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | IR60574215 | WA | N | Pharmacy Service Providers | Pharmacist | 183500000X | PH60713343 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.