Healthcare Provider Details

I. General information

NPI: 1255731360
Provider Name (Legal Business Name): FRITZI DOMINGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WESTLOOP PL
MANHATTAN KS
66502-2837
US

IV. Provider business mailing address

4107 10TH ST
GREAT BEND KS
67530-3450
US

V. Phone/Fax

Practice location:
  • Phone: 785-539-9454
  • Fax:
Mailing address:
  • Phone: 620-792-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16496
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: