Mikhail Domantovskiy, PHARM D

Primary specialty

PharmacistTaxonomy code 183500000X

License

28RI02864400 Issued in NJ

Practice address

2247 Ocean Heights Ave
Egg Harbor TWP, NJ 08234-5933

Phone

(609) 926-0283

NPI assigned

Jan 13, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  dba Walgreens # 13056

  • Pharmacy
  • Egg Harbor TWP, NJ
  • NPI 1083920995
  NPD
• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1134718208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 ZION RD",
            "city": "EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "082349637",
            "telephone_number": "609-927-6973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2247 OCEAN HEIGHTS AVE",
            "city": "EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "082345933",
            "telephone_number": "609-926-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMANTOVSKIY",
        "first_name": "MIKHAIL",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI02864400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cross Training Rehabilitation, LLC
• Matthew William Cross, M.S.P.T.
• Patrick Deveney
• Linda Mandata Dibartolo, D.C.
• Philip Anthony Dibartolo, D.C.
• Melissa Durkin, COTA
• Catherine A Dziegrenuk, RBT
• Emerging Transitions
• Family Choice Community Services LLC
• Family Service Association

• Pharmacist in Egg Harbor TWP, NJ
• Providers in Egg Harbor TWP, NJ by specialty
• Pharmacist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.