Organization
TARGET PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESSTEASE EMILE DOMINGUE PHARMD (PHARMACIST)
(757) 660-0013
Entity
Organization
Contact information
Practice address
4310 FORTUNA CENTER PLZ, DUMFRIES, VA 22025-1538
(703) 586-6133
Mailing address
4310 FORTUNA CENTER PLZ, DUMFRIES, VA 22025-1538
(703) 586-6133
Taxonomy
Speciality
Code
Description
License number
State
261QV0200X
VA Clinic/Center
Primary
0202212273
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202212273
VIRGINIA PHARMACY LICENSE
VA
Enumeration date
12/30/2015
Last updated
12/30/2015
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