Provider Demographics
NPI:1134409113
Name:SHALLAL, AMAL (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMAL
Middle Name:
Last Name:SHALLAL
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 1:3001 P ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3053
Mailing Address - Country:US
Mailing Address - Phone:202-337-4100
Mailing Address - Fax:202-337-4102
Practice Address - Street 1:3001 P ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3053
Practice Address - Country:US
Practice Address - Phone:202-337-4100
Practice Address - Fax:202-337-4102
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA2296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist