Healthcare Provider Details

I. General information

NPI: 1093291536
Provider Name (Legal Business Name): ISSA SALL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22131 SE 237TH ST
MAPLE VALLEY WA
98038-8533
US

IV. Provider business mailing address

13833 SE 78TH PL
NEWCASTLE WA
98059-9105
US

V. Phone/Fax

Practice location:
  • Phone: 425-433-2078
  • Fax: 425-358-5016
Mailing address:
  • Phone: 313-850-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH61451138
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: