Provider Demographics
NPI:1285221150
Name:DIERSING, DOMINIQUE DANIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:DANIELLE
Last Name:DIERSING
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 1:1576 PRESTON WOODS CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4017
Mailing Address - Country:US
Mailing Address - Phone:614-634-0259
Mailing Address - Fax:
Practice Address - Street 1:4582 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9724
Practice Address - Country:US
Practice Address - Phone:850-897-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-127326183500000X
FLPS65954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist