Provider Demographics
NPI:1891376943
Name:AMIN, MINA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 10TH AVE N STE 108
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3054
Mailing Address - Country:US
Mailing Address - Phone:954-388-4424
Mailing Address - Fax:877-258-8415
Practice Address - Street 1:2925 10TH AVE N STE 108
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3054
Practice Address - Country:US
Practice Address - Phone:954-388-4424
Practice Address - Fax:877-258-8415
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist