Provider Demographics
NPI:1699083956
Name:ISAAC, SHELBY J (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:J
Last Name:ISAAC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PHEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579
Mailing Address - Country:US
Mailing Address - Phone:845-284-2019
Mailing Address - Fax:212-342-2221
Practice Address - Street 1:7 PHEASNT RUN RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579
Practice Address - Country:US
Practice Address - Phone:845-284-2019
Practice Address - Fax:212-342-2111
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist