Individual
DR. AMANDA NICOLE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5626 N RIDGE AVE, CHICAGO, IL 60660-3483
(773) 989-7546
Mailing address
5626 N RIDGE AVE, CHICAGO, IL 60660-3483
(773) 989-7546
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.304064
IL
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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