Provider Demographics
NPI:1679869796
Name:ISAP, IMRAAN
Entity Type:Individual
Prefix:
First Name:IMRAAN
Middle Name:
Last Name:ISAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 S MARSHFIELD AVE
Mailing Address - Street 2:T-2344
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4902
Mailing Address - Country:US
Mailing Address - Phone:773-396-5507
Mailing Address - Fax:773-396-5517
Practice Address - Street 1:11840 S MARSHFIELD AVE
Practice Address - Street 2:T-2344
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4902
Practice Address - Country:US
Practice Address - Phone:773-396-5507
Practice Address - Fax:773-396-5517
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist