Provider Demographics
NPI:1093181190
Name:AMIN, ANIK VASUDEV (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANIK
Middle Name:VASUDEV
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 SE 13TH AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2554
Mailing Address - Country:US
Mailing Address - Phone:248-835-6448
Mailing Address - Fax:
Practice Address - Street 1:939 SW MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2727
Practice Address - Country:US
Practice Address - Phone:503-290-5362
Practice Address - Fax:503-290-5372
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist