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General NPI Number Information
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NPI Number | 1366710758
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Entity Type | Individual
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Provider Name | ISHA MALIK-ISMAIL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 201 E HURON ST STE 1-210
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City | CHICAGO
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State | IL
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Zip | 60611-3578
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Country | US
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Telephone | 312-951-1084
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Fax | 312-951-1227
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Provider Business Mailing Address
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Address Line | 201 E. HURON ST SUITE1-210
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-951-1084
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Fax | 312-951-1227
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051289331
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License Number State | IL
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