Basic Information
| Provider Information | |||||||||
| NPI: | 1396878930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHA | ||||||||
| FirstName: | ISAAC | ||||||||
| MiddleName: | HEONSANG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD, BCPS, BCADM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 RIDGEVIEW AVE | ||||||||
| Address2: | APT 3 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611075175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159857362 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 405 CHARLES ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610541646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157346061 | ||||||||
| FaxNumber: | 8157349021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | IL | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.