Provider Demographics
NPI:1881979037
Name:MANIAR, PARAG M (RPH)
Entity type:Individual
Prefix:MR
First Name:PARAG
Middle Name:M
Last Name:MANIAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10683 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:847-683-2244
Mailing Address - Fax:847-683-2277
Practice Address - Street 1:262 N STATE STREET
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-9720
Practice Address - Country:US
Practice Address - Phone:847-683-2244
Practice Address - Fax:847-683-2277
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051039732OtherPHARMACIST LIC