Provider Demographics
NPI:1538668975
Name:DOMBKOWSKI, KRISTYN EMILY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:EMILY
Last Name:DOMBKOWSKI
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 1:242 BELRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1012
Mailing Address - Country:US
Mailing Address - Phone:860-518-7870
Mailing Address - Fax:
Practice Address - Street 1:543 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3915
Practice Address - Country:US
Practice Address - Phone:860-225-6487
Practice Address - Fax:860-229-4488
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist