Healthcare Provider Details

I. General information

NPI: 1588660260
Provider Name (Legal Business Name): DOMINICK PETER TROMBETTA PHARM.D, BCPS, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GENOA LN
SHAVERTOWN PA
18708-9606
US

IV. Provider business mailing address

14 GENOA LN
SHAVERTOWN PA
18708-9606
US

V. Phone/Fax

Practice location:
  • Phone: 570-408-4324
  • Fax: 570-408-7729
Mailing address:
  • Phone: 570-408-4324
  • Fax: 570-408-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP032562-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: