Provider Demographics
NPI:1013528975
Name:AMIN, PRATIK K
Entity Type:Individual
Prefix:MR
First Name:PRATIK
Middle Name:K
Last Name:AMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 NORTHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-3030
Mailing Address - Country:US
Mailing Address - Phone:319-855-8854
Mailing Address - Fax:
Practice Address - Street 1:1045 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-3111
Practice Address - Country:US
Practice Address - Phone:319-385-8600
Practice Address - Fax:319-385-8602
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist