Healthcare Provider Details

I. General information

NPI: 1194075515
Provider Name (Legal Business Name): ANKUR B AMIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 11/24/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FITZGERALD DR
MIDDLETOWN NY
10940-3059
US

IV. Provider business mailing address

1 FITZGERALD DR
MIDDLETOWN NY
10940-3059
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-2930
  • Fax: 845-342-6898
Mailing address:
  • Phone: 845-343-2930
  • Fax: 845-342-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: