MEDICARE: DR. CANDISS ANN DOMINICK PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	16219	MD

General Provider Information

NPI Number	:	1851590491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDISS ANN DOMINICK PHARMD

Provider Business Mailing Address
First Line	:	3509 LORD BALTIMORE WAY
Second Line	:
City	:	MONKTON
State	:	MD
Zip	:	21111-1917
Country	:	US
Telephone Number	:	410-692-6033
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 LORD BALTIMORE WAY
Second Line	:
City	:	MONKTON
State	:	MD
Zip	:	21111-1917
Country	:	US
Telephone Number	:	410-692-6033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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