Healthcare Provider Details

I. General information

NPI: 1619001617
Provider Name (Legal Business Name): DOMENICA MARY O'DONNELL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOMENICA MARY PACIFIC PHARM.D.

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 OLD RIVER RD
MARCY NY
13403-3000
US

IV. Provider business mailing address

9005 OLD RIVER RD
MARCY NY
13403-3000
US

V. Phone/Fax

Practice location:
  • Phone: 315-765-3778
  • Fax:
Mailing address:
  • Phone: 315-765-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: