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General NPI Number Information
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NPI Number | 1548856677
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Entity Type | Individual
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Provider Name | DOMINIC LAWRENCE MILANESI
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Gender | Male
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Dates
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Enumeration Date | 12/13/2020
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 1120 PHILADELPHIA AVE
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City | NORTHERN CAMBRIA
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State | PA
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Zip | 15714-1359
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Country | US
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Telephone | 814-948-6102
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Fax |
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Provider Business Mailing Address
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Address Line | 514 BEECH AVE
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City | PATTON
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State | PA
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Zip | 16668-1310
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Country | US
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Telephone |
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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 | RP455033
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License Number State | PA
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