Provider Demographics
NPI:1942450911
Name:DOMIANO, HAZEL-ANN PATRICIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL-ANN
Middle Name:PATRICIA
Last Name:DOMIANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16438 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1242
Mailing Address - Country:US
Mailing Address - Phone:718-380-8529
Mailing Address - Fax:
Practice Address - Street 1:3106 FARRINGTON ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1906
Practice Address - Country:US
Practice Address - Phone:718-886-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist