MEDICARE: DR. CHAD ISAACS PHARMD

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	14075	OK
2	183500000X	Pharmacist	2008027651	MO

General Provider Information

NPI Number	:	1700066511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD ISAACS PHARMD

Provider Business Mailing Address
First Line	:	6059 N MAIN STREET RD.
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-7219
Country	:	US
Telephone Number	:	417-624-6590
Fax Number	:	417-624-6593

Provider Business Practice Location Address
First Line	:	6059 N MAIN STREET RD.
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-7219
Country	:	US
Telephone Number	:	417-624-6590
Fax Number	:	417-624-6593

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

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	02/26/2010

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