Provider Demographics
NPI:1558606517
Name:AMIN, PRADEEP (RPH)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9199 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-7673
Mailing Address - Country:US
Mailing Address - Phone:909-989-9800
Mailing Address - Fax:909-989-9877
Practice Address - Street 1:4150 N SIERRA WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407
Practice Address - Country:US
Practice Address - Phone:909-989-9800
Practice Address - Fax:909-989-9877
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40574183500000X
NV09406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist