Provider Demographics
NPI:1982175535
Name:RANA, MAYURKUMAR M
Entity Type:Individual
Prefix:
First Name:MAYURKUMAR
Middle Name:M
Last Name:RANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KOMISHANE'S PHARMACY
Practice Address - Street 2:199 STUYVESANT AVE
Practice Address - City:NEWAK
Practice Address - State:NJ
Practice Address - Zip Code:07106
Practice Address - Country:US
Practice Address - Phone:973-399-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03947300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03947300OtherNJ STATE BOARD OF PHARMACY