Provider Demographics
NPI:1790060465
Name:MANIAR, RUPAL P
Entity Type:Individual
Prefix:MRS
First Name:RUPAL
Middle Name:P
Last Name:MANIAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10683 NANTUCKET LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-4029
Mailing Address - Country:US
Mailing Address - Phone:847-669-3229
Mailing Address - Fax:
Practice Address - Street 1:4001 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9401
Practice Address - Country:US
Practice Address - Phone:224-569-2582
Practice Address - Fax:224-569-2783
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist