1568744167 NPI number — MRS. SHANA RENEE WILLIS PHARM.D. BCPS

Table of content: MRS. SHANA RENEE WILLIS PHARM.D. BCPS (NPI 1568744167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568744167 NPI number — MRS. SHANA RENEE WILLIS PHARM.D. BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIS
Provider First Name:
SHANA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D. BCPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNOOK
Provider Other First Name:
SHANA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568744167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S 43RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98055-5714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-228-3440
Provider Business Mailing Address Fax Number:
425-656-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S 43RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055-5714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-228-3440
Provider Business Practice Location Address Fax Number:
425-656-5447
Provider Enumeration Date:
09/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH60343606 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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