Provider Demographics
NPI:1568744167
Name:WILLIS, SHANA RENEE (PHARMD BCPS)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:RENEE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PHARMD BCPS
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:RENEE
Other - Last Name:SNOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:400 S 43RD ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5714
Mailing Address - Country:US
Mailing Address - Phone:425-228-3440
Mailing Address - Fax:425-656-5447
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-228-3440
Practice Address - Fax:425-656-5447
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60343606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist