Active NPI
Dominic James Maneval
- Pharmacist
- Wilkes Barre, PA
National Provider Identifier
1003406968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PI124803
- Practice address
- 620 Baltimore Dr
Wilkes Barre, PA 18702-7959 - Phone
- (570) 208-4721
- NPI assigned
- Jan 24, 2021
- Last updated
- Aug 22, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PI124803 | PA | Primary |
Addresses
Primary practice location
620 Baltimore Dr
Wilkes Barre, PA 18702-7959
Mailing address
949 Little League Rd
Jersey Shore, PA 17740-9007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PI124803 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Weis Markets Inc | Past | Accepting new patients | |
| Weis Markets Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1003406968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "949 LITTLE LEAGUE RD",
"city": "JERSEY SHORE",
"state": "PA",
"postal_code": "177409007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 BALTIMORE DR",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187027959",
"telephone_number": "570-208-4721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANEVAL",
"first_name": "DOMINIC",
"middle_name": "JAMES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-24",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "PI124803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.