Provider Demographics
NPI:1184061137
Name:MCISAAC, PAUL DANIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DANIEL
Last Name:MCISAAC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-1936
Mailing Address - Country:US
Mailing Address - Phone:609-330-3712
Mailing Address - Fax:
Practice Address - Street 1:2626 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-1936
Practice Address - Country:US
Practice Address - Phone:856-963-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03314100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist