Active NPI
Liliane Komguem Domkem
- Pharmacist
- Farmingville, NY
National Provider Identifier
1629255104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 050677
- Practice address
- 935 Horseblock Rd
Farmingville, NY 11738-1228 - Phone
- (631) 698-7914
- Fax
- (631) 698-9240
- NPI assigned
- Jan 27, 2008
- Sex
- Female
- 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 | 050677 | NY | Primary |
Addresses
Primary practice location
935 Horseblock Rd
Farmingville, NY 11738-1228
Mailing address
935 Horseblock Rd
Farmingville, NY 11738-1228
Phone (631) 698-7914
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 |
|---|---|---|---|
| 050677 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- Brooklyn, RI
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201392000000",
"number": "1629255104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "935 HORSEBLOCK RD",
"city": "FARMINGVILLE",
"state": "NY",
"postal_code": "117381228",
"telephone_number": "631-698-7914",
"fax_number": "631-698-9240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "935 HORSEBLOCK RD",
"city": "FARMINGVILLE",
"state": "NY",
"postal_code": "117381228",
"telephone_number": "631-698-7914",
"fax_number": "631-698-9240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMKEM",
"first_name": "LILIANE",
"middle_name": "KOMGUEM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-27",
"last_updated": "2008-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "050677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmingville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.