Provider Demographics
NPI:1619593100
Name:DOMOND, GENIKA (RPH)
Entity type:Individual
Prefix:DR
First Name:GENIKA
Middle Name:
Last Name:DOMOND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 E KETRING CT
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-7912
Mailing Address - Country:US
Mailing Address - Phone:909-810-6499
Mailing Address - Fax:
Practice Address - Street 1:1861 S SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5605
Practice Address - Country:US
Practice Address - Phone:951-487-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83916183500000X
OH03337712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist