Provider Demographics
NPI:1386940476
Name:BOLOS, SHERINE (PHARMD)
Entity type:Individual
Prefix:
First Name:SHERINE
Middle Name:
Last Name:BOLOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHERINE
Other - Middle Name:
Other - Last Name:GOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12400 E MARGINAL WAY S
Mailing Address - Street 2:AMB-2 PHARMACY ADMINSTRATION
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12400 E MARGINAL WAY S
Practice Address - Street 2:AMB-2 PHARMACY ADMINSTRATION
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-2559
Practice Address - Country:US
Practice Address - Phone:425-901-7497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60174616183500000X
FLPS41544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist