Provider Demographics
NPI:1366710758
Name:MALIK-ISMAIL, ISHA (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ISHA
Middle Name:
Last Name:MALIK-ISMAIL
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 1:201 E. HURON ST SUITE1-210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-951-1084
Mailing Address - Fax:312-951-1227
Practice Address - Street 1:201 E HURON ST STE 1-210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3578
Practice Address - Country:US
Practice Address - Phone:312-951-1084
Practice Address - Fax:312-951-1227
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist