MEDICARE: DR. ISAAC HEONSANG CHA PHARMD, BCPS, BCADM

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	1835P1200X	Pharmacotherapy Pharmacist		IL

General Provider Information

NPI Number	:	1396878930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAAC HEONSANG CHA PHARMD, BCPS, BCADM

Provider Business Mailing Address
First Line	:	335 RIDGEVIEW AVE
Second Line	:	APT 3
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5175
Country	:	US
Telephone Number	:	815-985-7362
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 CHARLES ST
Second Line	:
City	:	MOUNT MORRIS
State	:	IL
Zip	:	61054-1646
Country	:	US
Telephone Number	:	815-734-6061
Fax Number	:	815-734-9021

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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