Provider Demographics
NPI:1255954830
Name:DOKIMOS, DAVID J (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:DOKIMOS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5854
Mailing Address - Country:US
Mailing Address - Phone:530-274-0100
Mailing Address - Fax:530-274-0100
Practice Address - Street 1:640 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5854
Practice Address - Country:US
Practice Address - Phone:530-274-0100
Practice Address - Fax:530-274-7500
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH37912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist