Healthcare Provider Details

I. General information

NPI: 1396733986
Provider Name (Legal Business Name): DON M DIDOMENICO RPH, CDM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S BUCKLEY RD
AURORA CO
80017-4150
US

IV. Provider business mailing address

1200 S BUCKLEY RD
AURORA CO
80017-4150
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-8342
  • Fax: 303-750-8349
Mailing address:
  • Phone: 303-750-8346
  • Fax: 303-750-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9269
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: