Provider Demographics
NPI:1811242548
Name:ALI, SHAIMAA A (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHAIMAA
Middle Name:A
Last Name:ALI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 BRIDGEPORT WAY W
Mailing Address - Street 2:# A 303
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4447
Mailing Address - Country:US
Mailing Address - Phone:253-341-6883
Mailing Address - Fax:253-460-0440
Practice Address - Street 1:3905 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4417
Practice Address - Country:US
Practice Address - Phone:253-565-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60036757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60036757OtherWA STATE PHARMACIST LICENSE