Healthcare Provider Details

I. General information

NPI: 1396878930
Provider Name (Legal Business Name): ISAAC HEONSANG CHA PHARMD, BCPS, BCADM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CHARLES ST
MOUNT MORRIS IL
61054-1646
US

IV. Provider business mailing address

335 RIDGEVIEW AVE APT 3
ROCKFORD IL
61107-5175
US

V. Phone/Fax

Practice location:
  • Phone: 815-734-6061
  • Fax: 815-734-9021
Mailing address:
  • Phone: 815-985-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: