Provider Demographics
NPI:1952971186
Name:CONTI, DOMINIC THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:THOMAS
Last Name:CONTI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 NORTHEAST AVE APT E206
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1474
Mailing Address - Country:US
Mailing Address - Phone:440-654-1080
Mailing Address - Fax:
Practice Address - Street 1:306 NORTHEAST AVE APT E206
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1474
Practice Address - Country:US
Practice Address - Phone:440-654-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0340240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist