Healthcare Provider Details

I. General information

NPI: 1902181126
Provider Name (Legal Business Name): DOMINICA MARIE HOFFMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 PAGE AVE
SAINT LOUIS MO
63132-1016
US

IV. Provider business mailing address

6238 WESTMINSTER PL
SAINT LOUIS MO
63130-4848
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-1804
  • Fax: 314-447-1810
Mailing address:
  • Phone: 314-726-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042009
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: