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General NPI Number Information
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NPI Number | 1548583495
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Entity Type | Individual
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Provider Name | LISA DIDOMENICO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 110 S WORK ST
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City | FALCONER
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State | NY
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Zip | 14733-1434
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Country | US
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Telephone | 716-665-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 4280 SALISBURY RD
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City | BEMUS POINT
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State | NY
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Zip | 14712-9747
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Country | US
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Telephone | 716-386-5431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051339
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License Number State | NY
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