Healthcare Provider Details

I. General information

NPI: 1043535719
Provider Name (Legal Business Name): DOMINICK OGNIBENE R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 POWERS FERRY RD
CARY NC
27519-1508
US

IV. Provider business mailing address

407 POWERS FERRY RD
CARY NC
27519-1508
US

V. Phone/Fax

Practice location:
  • Phone: 919-267-6573
  • Fax:
Mailing address:
  • Phone: 919-267-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18194
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: