Provider Demographics
NPI:1194223297
Name:AMIN, VISHALI (PHARMD)
Entity Type:Individual
Prefix:
First Name:VISHALI
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 N PEORIA ST UNIT 3N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6914
Mailing Address - Country:US
Mailing Address - Phone:661-319-1150
Mailing Address - Fax:
Practice Address - Street 1:664 N PEORIA ST UNIT 3N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6914
Practice Address - Country:US
Practice Address - Phone:661-319-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist