Provider Demographics
NPI:1164286498
Name:AMIN, MEHUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEHUL
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MEHUL
Other - Middle Name:
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:47 S LOCUST ST, MANTENO, IL 60950
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950
Mailing Address - Country:US
Mailing Address - Phone:312-973-8222
Mailing Address - Fax:
Practice Address - Street 1:47 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1515
Practice Address - Country:US
Practice Address - Phone:815-468-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051306078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist