MEDICARE: JOHN ISAACS

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	1-9683	KS

General Provider Information

NPI Number	:	1992250005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ISAACS

Provider Business Mailing Address
First Line	:	1001 W 11TH ST
Second Line	:
City	:	COFFEYVILLE
State	:	KS
Zip	:	67337-4220
Country	:	US
Telephone Number	:	620-251-2150
Fax Number	:	620-251-0022

Provider Business Practice Location Address
First Line	:	1001 W 11TH ST
Second Line	:
City	:	COFFEYVILLE
State	:	KS
Zip	:	67337-4220
Country	:	US
Telephone Number	:	620-251-2150
Fax Number	:	620-251-0022

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

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	08/18/2016

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