Healthcare Provider Details

I. General information

NPI: 1336291574
Provider Name (Legal Business Name): CHARLES DOMINGUEZ PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MUIR ROAD INPATIENT PHARMACY
MARTINEZ CA
94553
US

IV. Provider business mailing address

1115 EARNEST STREET
HERCULES CA
94547
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-1510
  • Fax:
Mailing address:
  • Phone: 510-964-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH52622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: