Provider Demographics
NPI:1588949911
Name:DOMEIKA, ALGIS T (RPH)
Entity type:Individual
Prefix:MR
First Name:ALGIS
Middle Name:T
Last Name:DOMEIKA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OLD ROD RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1957
Mailing Address - Country:US
Mailing Address - Phone:203-858-2880
Mailing Address - Fax:
Practice Address - Street 1:295 MAIN ST.
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-649-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0008592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist