Provider Demographics
NPI:1770875940
Name:DOMIN-SHORTEN, PATRICIA CE (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CE
Last Name:DOMIN-SHORTEN
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 1:42 MAIN STREET
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976
Mailing Address - Country:US
Mailing Address - Phone:570-462-1924
Mailing Address - Fax:
Practice Address - Street 1:42 MAIN STREET
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976
Practice Address - Country:US
Practice Address - Phone:570-462-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039350L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist