Provider Demographics
NPI:1598045072
Name:AMIN, JYOTIKA P
Entity Type:Individual
Prefix:MRS
First Name:JYOTIKA
Middle Name:P
Last Name:AMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5294
Mailing Address - Country:US
Mailing Address - Phone:630-789-3637
Mailing Address - Fax:630-789-3637
Practice Address - Street 1:10S370 RTE 83
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-6140
Practice Address - Country:US
Practice Address - Phone:630-655-2733
Practice Address - Fax:630-655-3991
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist