Most Relevant Information
Provider Data
| NPI Number: | 1003589359 |
| Provider Name: | AMANDA NICOLE DOMINGUEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 051.304064 |
Most Important Dates
| Enumeration Date: | 07/30/2021 |
| Last Updated: | 07/30/2021 |
Provider Practice Location
5626 N RIDGE AVE
CHICAGO
IL
606603483
Practice Location Phone/Fax
| Phone: | 7739897546 |
| Fax: |
Provider Mailing Location
5626 N RIDGE AVE
CHICAGO
IL
606603483
Provider Mailing Phone/Fax
| Phone: | 7739897546 |
| Fax: |