Provider Demographics
NPI:1851590491
Name:DOMINICK, CANDISS ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CANDISS
Middle Name:ANN
Last Name:DOMINICK
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 1:3509 LORD BALTIMORE WAY
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1917
Mailing Address - Country:US
Mailing Address - Phone:410-692-6033
Mailing Address - Fax:
Practice Address - Street 1:3509 LORD BALTIMORE WAY
Practice Address - Street 2:
Practice Address - City:MONKTON
Practice Address - State:MD
Practice Address - Zip Code:21111-1917
Practice Address - Country:US
Practice Address - Phone:410-692-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist