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Individual

MARK DOMINIQUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARM.D, LCSW

Contact information

Practice address
65 WESTERN AVE, RITE AID, HAMPDEN, ME 04444-1423
(207) 862-4900
Mailing address
65 WESTERN AVE, HAMPDEN, ME 04444-1423
(207) 862-4900

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LC12200
ME
183500000X
Pharmacist
Primary
PR6065
ME

Other

Enumeration date
10/01/2009
Last updated
07/17/2013
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