Provider Demographics
NPI:1114208618
Name:AMIN, NIRAV (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NIRAV
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16675 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1754
Mailing Address - Country:US
Mailing Address - Phone:708-429-0880
Mailing Address - Fax:708-429-0384
Practice Address - Street 1:501 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4908
Practice Address - Country:US
Practice Address - Phone:312-492-8559
Practice Address - Fax:312-492-8564
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL051.292960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist