Provider Demographics
NPI:1154608941
Name:AMIN, JYOTIKA C (RPH)
Entity type:Individual
Prefix:MRS
First Name:JYOTIKA
Middle Name:C
Last Name:AMIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11435 MILDRED CT
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1011
Mailing Address - Country:US
Mailing Address - Phone:708-588-1253
Mailing Address - Fax:
Practice Address - Street 1:6600 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-4593
Practice Address - Country:US
Practice Address - Phone:708-588-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051030391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist