Provider Demographics
NPI:1275925885
Name:ISIT, SHEILA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:ISIT
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S PROSPECT ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2423
Mailing Address - Country:US
Mailing Address - Phone:630-456-8434
Mailing Address - Fax:815-633-0853
Practice Address - Street 1:1704 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4850
Practice Address - Country:US
Practice Address - Phone:815-633-0475
Practice Address - Fax:815-633-0853
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist