MEDICARE: FAITH JOY ISADA CANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051302344	IL

General Provider Information

NPI Number	:	1013563964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH JOY ISADA CANA

Provider Business Mailing Address
First Line	:	5259 N MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4745 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4410
Country	:	US
Telephone Number	:	773-481-0211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	08/15/2019

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Directions to “ FAITH JOY ISADA CANA ” Practice Location

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