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 1:6985 OFFICE PARK DR UNIT 247
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2339
Mailing Address - Country:US
Mailing Address - Phone:909-810-6499
Mailing Address - Fax:
Practice Address - Street 1:700 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6202
Practice Address - Country:US
Practice Address - Phone:513-425-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist