Provider Demographics
NPI:1164609137
Name:VIOLA, DOMENICA N (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DOMENICA
Middle Name:N
Last Name:VIOLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:DOMENICA
Other - Middle Name:N
Other - Last Name:PANEPUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:903 CLINTONVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1231
Mailing Address - Country:US
Mailing Address - Phone:718-767-7720
Mailing Address - Fax:
Practice Address - Street 1:150-43B-14 AVENUE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-5034
Practice Address - Country:US
Practice Address - Phone:718-767-0618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02783306Medicaid