Provider Demographics
NPI:1063904761
Name:AKOTIA, ANANTA AMIN
Entity type:Individual
Prefix:
First Name:ANANTA
Middle Name:AMIN
Last Name:AKOTIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANANTA
Other - Middle Name:PRADEEPKUMAR
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8661 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1111
Mailing Address - Country:US
Mailing Address - Phone:909-989-9800
Mailing Address - Fax:
Practice Address - Street 1:8661 BASELINE RD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1111
Practice Address - Country:US
Practice Address - Phone:909-989-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist