Provider Demographics
NPI:1235467911
Name:ISSAC, RENY JACOB (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:RENY
Middle Name:JACOB
Last Name:ISSAC
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9705 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4071
Mailing Address - Country:US
Mailing Address - Phone:281-470-7428
Mailing Address - Fax:
Practice Address - Street 1:9705 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4071
Practice Address - Country:US
Practice Address - Phone:281-470-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist