Provider Demographics
NPI:1114265394
Name:SHAKIR, ZILLEHUMA (PH60266122)
Entity Type:Individual
Prefix:
First Name:ZILLEHUMA
Middle Name:
Last Name:SHAKIR
Suffix:
Gender:F
Credentials:PH60266122
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23606 105TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3354
Mailing Address - Country:US
Mailing Address - Phone:206-290-1319
Mailing Address - Fax:
Practice Address - Street 1:17801 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6423
Practice Address - Country:US
Practice Address - Phone:425-235-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60266122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist