Healthcare Provider Details

I. General information

NPI: 1396261079
Provider Name (Legal Business Name): KUNAL AMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 STATE ROUTE 44 STE 207-208
ROOTSTOWN OH
44272-9733
US

IV. Provider business mailing address

10073 SUNDOWN TRL
NORTH ROYALTON OH
44133-6187
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-6157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03129618
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: