Provider Demographics
NPI:1649098476
Name:BARAN, DOMINIK (RPH)
Entity type:Individual
Prefix:DR
First Name:DOMINIK
Middle Name:
Last Name:BARAN
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 1:235 MACDONALD DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3845
Mailing Address - Country:US
Mailing Address - Phone:862-579-5555
Mailing Address - Fax:
Practice Address - Street 1:115 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2013
Practice Address - Country:US
Practice Address - Phone:973-962-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04399700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist