Healthcare Provider Details

I. General information

NPI: 1992551188
Provider Name (Legal Business Name): PATEL RANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S CLARK ST
CHICAGO IL
60605-1703
US

IV. Provider business mailing address

701 S CLARK ST
CHICAGO IL
60605-1703
US

V. Phone/Fax

Practice location:
  • Phone: 773-200-2616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ISHAN PATEL
Title or Position: PRESIDENT
Credential:
Phone: 773-200-2616