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General NPI Number Information
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NPI Number | 1710011721
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Entity Type | Individual
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Provider Name | DOMINICK DEGENNARO RPH
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1141 WANTAGH AVE PHARMACY
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City | WANTAGH
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State | NY
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Zip | 11793-2135
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Country | US
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Telephone | 516-783-4300
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Fax | 516-783-3669
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Provider Business Mailing Address
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Address Line | 3606 LADONIA ST
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City | SEAFORD
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State | NY
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Zip | 11783-3023
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Country | US
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Telephone | 516-783-5949
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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 | 032434
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License Number State | NY
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