Provider Demographics
NPI:1992329841
Name:SHOUKRALA, PETER (BPHARM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SHOUKRALA
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21511 4TH AVE W UNIT A62
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7573
Mailing Address - Country:US
Mailing Address - Phone:425-215-6756
Mailing Address - Fax:
Practice Address - Street 1:20812 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8404
Practice Address - Country:US
Practice Address - Phone:425-398-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60975314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist