Provider Demographics
NPI:1700428554
Name:KUMARAN, NITA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NITA
Middle Name:
Last Name:KUMARAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 NEWPORT CT
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-3039
Mailing Address - Country:US
Mailing Address - Phone:309-370-8234
Mailing Address - Fax:
Practice Address - Street 1:27 NEWPORT CT
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-3039
Practice Address - Country:US
Practice Address - Phone:309-370-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist