Provider Demographics
NPI:1548560287
Name:SARRIA-WILEY, DOMINIC JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:JAMES
Last Name:SARRIA-WILEY
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 1:400 N RUBY ST
Mailing Address - Street 2:PHARMACY DEPT.
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3152
Mailing Address - Country:US
Mailing Address - Phone:509-962-5096
Mailing Address - Fax:509-925-6044
Practice Address - Street 1:400 N RUBY ST
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3152
Practice Address - Country:US
Practice Address - Phone:509-962-5096
Practice Address - Fax:509-925-6044
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60086003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist