Provider Demographics
NPI:1235222415
Name:DORMINEY, WENDY ANN (PHARM D CDM)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANN
Last Name:DORMINEY
Suffix:
Gender:F
Credentials:PHARM D CDM
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:KUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5409 FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636
Mailing Address - Country:US
Mailing Address - Phone:229-559-1318
Mailing Address - Fax:229-559-9408
Practice Address - Street 1:1016 LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636
Practice Address - Country:US
Practice Address - Phone:229-559-9398
Practice Address - Fax:229-559-9408
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4028520002Medicare ID - Type Unspecified