Provider Demographics
NPI:1144664160
Name:MADHANI, AMYN (PHARMD)
Entity type:Individual
Prefix:
First Name:AMYN
Middle Name:
Last Name:MADHANI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12511 JONES MALTSBERGER RD
Mailing Address - Street 2:#3103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4268
Mailing Address - Country:US
Mailing Address - Phone:469-583-6414
Mailing Address - Fax:
Practice Address - Street 1:910 KITTY HAWK RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3806
Practice Address - Country:US
Practice Address - Phone:210-945-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist