Provider Demographics
NPI:1437460979
Name:AIDOO, DOMINIC (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:
Last Name:AIDOO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43944 SWIFT FOX DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-7136
Mailing Address - Country:US
Mailing Address - Phone:301-481-9928
Mailing Address - Fax:240-309-4151
Practice Address - Street 1:25805 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2038
Practice Address - Country:US
Practice Address - Phone:301-481-9928
Practice Address - Fax:240-309-4151
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist