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General NPI Number Information
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NPI Number | 1558579649
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Entity Type | Individual
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Provider Name | MR. DOMINIC ROBERT GASDIA
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Gender | Male
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 328 SAINT JOHN ST
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-2817
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Country | US
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Telephone | 410-939-4545
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Fax | 410-939-7780
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Provider Business Mailing Address
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Address Line | 945 NENA AVE
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-2318
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Country | US
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Telephone | 410-939-2421
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Fax | 410-939-7780
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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 | 08479
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License Number State | MD
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