Provider Demographics
NPI:1336353804
Name:AMIN, SHEETAL (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHEETAL
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 LOS MONTEROS
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-5110
Mailing Address - Country:US
Mailing Address - Phone:714-469-8261
Mailing Address - Fax:714-692-3284
Practice Address - Street 1:22343 LA PALMA AVE STE 114
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3805
Practice Address - Country:US
Practice Address - Phone:714-692-3261
Practice Address - Fax:714-692-3284
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46664OtherPHARMACY LIC N0