Provider Demographics
NPI:1821563594
Name:AMIN, KETUL N (PHARMD)
Entity Type:Individual
Prefix:
First Name:KETUL
Middle Name:N
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSAL DR N
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3156
Mailing Address - Country:US
Mailing Address - Phone:203-859-3491
Mailing Address - Fax:203-937-2557
Practice Address - Street 1:200 UNIVERSAL DR N
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3156
Practice Address - Country:US
Practice Address - Phone:203-859-3491
Practice Address - Fax:203-937-2557
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237872183500000X
CTPCT.0014256183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist