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General NPI Number Information
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NPI Number | 1306860960
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Entity Type | Individual
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Provider Name | LILLIAM MARIA DOMINGUEZ PHARMACY TECHNICIAN
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 225 CALLE MARGINAL SUITE 2 BO MAGINA
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City | SABANA GRANDE
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State | PR
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Zip | 00637-3004
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Country | US
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Telephone | 787-873-1480
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Fax | 787-873-1480
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Provider Business Mailing Address
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Address Line | 939 CALLE SAMARIA URB VILLA DEL CARMEN
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City | PONCE
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State | PR
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Zip | 00716-2129
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Country | US
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Telephone | 787-873-1480
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Fax | 787-873-1480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 2866
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License Number State | PR
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