Healthcare Provider Details

I. General information

NPI: 1528297421
Provider Name (Legal Business Name): ISABEL PORTO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S WOOD ST
CHICAGO IL
60612-7229
US

IV. Provider business mailing address

8306 TUDOR CIR
WILLOW SPRINGS IL
60480-1123
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2021
  • Fax:
Mailing address:
  • Phone: 312-996-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051040010
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: