Provider Demographics
NPI:1780309278
Name:VIRPARIA, KANAIYALAL B (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KANAIYALAL
Middle Name:B
Last Name:VIRPARIA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17017 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6932
Mailing Address - Country:US
Mailing Address - Phone:815-666-9441
Mailing Address - Fax:
Practice Address - Street 1:16760 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-4601
Practice Address - Country:US
Practice Address - Phone:815-834-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist