Individual
EDWIN PAUL DOMINGUE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.D.
Contact information
Practice address
105 DUNCAN DR, LAFAYETTE, LA 70503-4756
(337) 988-2711
Mailing address
105 DUNCAN DR, LAFAYETTE, LA 70503-4756
(337) 988-2711
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST 10459
LA
Other
Enumeration date
11/20/2013
Last updated
11/20/2013
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