Healthcare Provider Details

I. General information

NPI: 1124931712
Provider Name (Legal Business Name): ERICA RENEE DOMER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

8903 E NORWOOD CIR
MESA AZ
85207-1447
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5420
  • Fax:
Mailing address:
  • Phone: 602-344-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS018669
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: