Provider Demographics
NPI:1649579178
Name:ISAACS, DIANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ISAACS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2527 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4648
Mailing Address - Country:US
Mailing Address - Phone:847-322-3474
Mailing Address - Fax:
Practice Address - Street 1:10685 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1501
Practice Address - Country:US
Practice Address - Phone:216-444-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist