Provider Demographics
NPI:1710269923
Name:PHILIP, DOMY (RPH)
Entity Type:Individual
Prefix:
First Name:DOMY
Middle Name:
Last Name:PHILIP
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 1:29 N PARK TER
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2140
Mailing Address - Country:US
Mailing Address - Phone:845-267-8256
Mailing Address - Fax:
Practice Address - Street 1:16 ROUTE 59
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2913
Practice Address - Country:US
Practice Address - Phone:845-358-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055808-1183500000X
NJ28RI03204400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist