Provider Demographics
NPI:1558813931
Name:SHAWISH, AMAL
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:SHAWISH
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 1:4401 186TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8856
Mailing Address - Country:US
Mailing Address - Phone:425-949-6768
Mailing Address - Fax:
Practice Address - Street 1:1400 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8515
Practice Address - Country:US
Practice Address - Phone:425-741-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60574215183500000X
WAPH60713343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist