Individual
CASSIDY LOUISE DOMAGALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
126 OAK ST, PEORIA, IL 61602-1639
(309) 690-7790
(866) 385-4948
Mailing address
817 NORMAL AVE, NORMAL, IL 61761-1531
(708) 516-4718
Taxonomy
Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
Primary
051.296273
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051.296273
STATE LICENSE
IL
Enumeration date
03/30/2021
Last updated
03/30/2021
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