Provider Demographics
NPI:1972970929
Name:AMIN, SONAL SACHIN
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:SACHIN
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 1:2447 BRIDGE CIR APT 207
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2374
Mailing Address - Country:US
Mailing Address - Phone:347-448-1105
Mailing Address - Fax:
Practice Address - Street 1:2104 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3118
Practice Address - Country:US
Practice Address - Phone:423-622-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54014183500000X
TN39906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist