Individual provider Active NPI

Kristen Dominik, PHARMD

  • Pharmacist
  • Baltimore, MD
National Provider Identifier
1902233679
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
20856 Issued in MD
Practice address
2809 Boston St
Baltimore, MD 21224-4814
Phone
(724) 972-3123
NPI assigned
Sep 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 20856 MD Primary

Addresses

Primary practice location

2809 Boston St
Baltimore, MD 21224-4814

Mailing address

9760 Barnes Lake Rd
North Huntingdon, PA 15642-3135
Phone (724) 972-3123

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
20856MDMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397606400000",
    "number": "1902233679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9760 BARNES LAKE RD",
            "city": "NORTH HUNTINGDON",
            "state": "PA",
            "postal_code": "156423135",
            "telephone_number": "724-972-3123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 BOSTON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212244814",
            "telephone_number": "724-972-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINIK",
        "first_name": "KRISTEN",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-26",
        "last_updated": "2014-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "20856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2014; 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.