Provider Demographics
NPI:1295227742
Name:LOULOU, SALAH EDDIN HICHAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:SALAH EDDIN
Middle Name:HICHAM
Last Name:LOULOU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18321 52ND AVE W APT 180
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4413
Mailing Address - Country:US
Mailing Address - Phone:206-602-7575
Mailing Address - Fax:
Practice Address - Street 1:23028 100TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5080
Practice Address - Country:US
Practice Address - Phone:425-774-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60819903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist