MEDICARE: DR. DOMINIQUE MAURICE PHARM. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	050669	NY

General Provider Information

NPI Number	:	1942479878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIQUE MAURICE PHARM. D.

Provider Business Mailing Address
First Line	:	520 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1914
Country	:	US
Telephone Number	:	718-858-8562
Fax Number	:	718-858-0172

Provider Business Practice Location Address
First Line	:	520 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1914
Country	:	US
Telephone Number	:	718-858-8562
Fax Number	:	718-858-0172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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