Provider Demographics
NPI:1578893798
Name:PODIX, DOMENIC (PHARM D)
Entity Type:Individual
Prefix:
First Name:DOMENIC
Middle Name:
Last Name:PODIX
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6716
Mailing Address - Country:US
Mailing Address - Phone:602-283-0782
Mailing Address - Fax:602-283-0785
Practice Address - Street 1:2650 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6716
Practice Address - Country:US
Practice Address - Phone:602-283-0782
Practice Address - Fax:602-283-0785
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist