Provider Demographics
NPI:1174238109
Name:SHOKRALLA, BEATRICE AMIR
Entity type:Individual
Prefix:MISS
First Name:BEATRICE
Middle Name:AMIR
Last Name:SHOKRALLA
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 1:4745 40TH AVE SW APT 411
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4625
Mailing Address - Country:US
Mailing Address - Phone:206-446-6445
Mailing Address - Fax:
Practice Address - Street 1:4300 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5008
Practice Address - Country:US
Practice Address - Phone:425-873-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH12860241835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist