Provider Demographics
NPI:1083908040
Name:DOMINY, KRISTY LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:DOMINY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 E VICTORY DR
Mailing Address - Street 2:T-2331
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-3714
Mailing Address - Country:US
Mailing Address - Phone:912-644-1601
Mailing Address - Fax:
Practice Address - Street 1:1907 E VICTORY DR
Practice Address - Street 2:T-2331
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3714
Practice Address - Country:US
Practice Address - Phone:912-644-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH-024434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist