Active NPI
Woodly Domond
- Pharmacist
- Brooklyn, NY
National Provider Identifier
1629719208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 068617
- Practice address
- 1106 Saint Johns PL
Brooklyn, NY 11213-2699 - Phone
- (718) 221-4805
- NPI assigned
- Apr 6, 2022
- 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 | 068617 | NY | Primary |
Addresses
Primary practice location
1106 Saint Johns PL
Brooklyn, NY 11213-2699
Mailing address
3571 Nostrand Ave Apt 1E
Brooklyn, NY 11229-5234
Phone (347) 463-5895
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 |
|---|---|---|---|
| 068617 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649203200000",
"number": "1629719208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3571 NOSTRAND AVE APT 1E",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112295234",
"telephone_number": "347-463-5895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1106 SAINT JOHNS PL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112132699",
"telephone_number": "718-221-4805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMOND",
"first_name": "WOODLY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-06",
"last_updated": "2022-04-06",
"certification_date": "2022-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "068617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.