Provider Demographics
NPI:1396878930
Name:CHA, ISAAC HEONSANG (PHARMD, BCPS, BCADM)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:HEONSANG
Last Name:CHA
Suffix:
Gender:M
Credentials:PHARMD, BCPS, BCADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 RIDGEVIEW AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5175
Mailing Address - Country:US
Mailing Address - Phone:815-985-7362
Mailing Address - Fax:
Practice Address - Street 1:405 CHARLES ST
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:IL
Practice Address - Zip Code:61054-1646
Practice Address - Country:US
Practice Address - Phone:815-734-6061
Practice Address - Fax:815-734-9021
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy