Organization
DOMINGUEZ PHARMACY LP
Active
Organization
DOMINGUEZ PHARMACY LP
Active
Other names
Dominguez Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRES DOMINGUEZ (GENERAL PARTNER)
(951) 943-8188
Entity
Organization
Contact information
Practice address
31739 RIVERSIDE DR, LAKE ELSINORE, CA 92530-7818
(951) 674-4600
(951) 674-4660
Mailing address
1175 E ARROW HWY, SUITE K, UPLAND, CA 91786-5525
(909) 981-1009
(909) 981-3612
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
49914
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336373646
—
CA
01
—
5634387
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/14/2009
Last updated
12/03/2010
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