Provider Demographics
NPI:1346971975
Name:MESSINA, DOMINIC RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:RICHARD
Last Name:MESSINA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5827 NATURE VIEW DR APT 203
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5137
Mailing Address - Country:US
Mailing Address - Phone:618-520-6693
Mailing Address - Fax:
Practice Address - Street 1:5710 YOUNG PINE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829
Practice Address - Country:US
Practice Address - Phone:689-837-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist