Healthcare Provider Details

I. General information

NPI: 1568278943
Provider Name (Legal Business Name): RUTU AMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 WELSH RD
PHILADELPHIA PA
19114-3238
US

IV. Provider business mailing address

9130 MATHER ST
PHILADELPHIA PA
19115-4688
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-0544
  • Fax:
Mailing address:
  • Phone: 267-575-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP459076
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: