Provider Demographics
NPI:1922519586
Name:AMIN, AGAM AMAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:AGAM
Middle Name:AMAR
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 1:2843 HAWK RD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3481
Mailing Address - Country:US
Mailing Address - Phone:951-415-7553
Mailing Address - Fax:
Practice Address - Street 1:2843 HAWK RD
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3481
Practice Address - Country:US
Practice Address - Phone:951-415-7553
Practice Address - Fax:951-415-7553
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist