Individual
JON PAUL DOMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
36567 GODDARD RD, ROMULUS, MI 48174-1232
(734) 941-0755
(734) 941-8771
Mailing address
36567 GODDARD RD, ROMULUS, MI 48174-1232
(734) 941-0755
(734) 941-8771
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302026267
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302026267
STATE OF MICHIGAN DEPT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
09/02/2015
Last updated
02/26/2020
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