=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801929104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGH ANN DOMINEY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1650 AIRPORT BLVD
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32504-8618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-484-4555
-----------------------------------------------------
Fax | 850-476-3337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10606 SANTORINI CT
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32507-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-492-6210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS41250
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------