Provider Demographics
NPI:1619001617
Name:O'DONNELL, DOMENICA MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICA
Middle Name:MARY
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DOMENICA
Other - Middle Name:MARY
Other - Last Name:PACIFIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9005 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-3000
Mailing Address - Country:US
Mailing Address - Phone:315-765-3778
Mailing Address - Fax:
Practice Address - Street 1:9005 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-3000
Practice Address - Country:US
Practice Address - Phone:315-765-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist