Provider Demographics
NPI:1386993798
Name:TROMBETTA, DOMENICA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DOMENICA
Middle Name:
Last Name:TROMBETTA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DOBBS LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1436
Mailing Address - Country:US
Mailing Address - Phone:856-685-7440
Mailing Address - Fax:856-685-7490
Practice Address - Street 1:100 DOBBS LN
Practice Address - Street 2:SUITE 205
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1436
Practice Address - Country:US
Practice Address - Phone:856-685-7440
Practice Address - Fax:856-685-7490
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02099500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3144499OtherNABP