Healthcare Provider Details

I. General information

NPI: 1396943429
Provider Name (Legal Business Name): LYNN ZWIERCAN DOMPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 US HIGHWAY 1 S STE 120
SAINT AUGUSTINE FL
32086-6354
US

IV. Provider business mailing address

3670 US HIGHWAY 1 S STE 120
SAINT AUGUSTINE FL
32086-6354
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-1399
  • Fax: 904-794-1193
Mailing address:
  • Phone: 904-794-1399
  • Fax: 904-794-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0027587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: