Provider Demographics
NPI:1073116653
Name:ISSA, OLA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OLA
Middle Name:M
Last Name:ISSA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 W DIVERSEY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-7173
Mailing Address - Country:US
Mailing Address - Phone:773-673-5493
Mailing Address - Fax:
Practice Address - Street 1:2545 W DIVERSEY AVE STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-7173
Practice Address - Country:US
Practice Address - Phone:773-673-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist