NPI Code Detail JSON Logo

1598620734 NPI number — DOMINO MED PHARMACY LLC

NPI Number: 1598620734
Health Care Provider/Practitioner: DOMINO MED PHARMACY LLC

Information about “1598620734” NPI (DOMINO MED PHARMACY LLC) exists in 1598620734 in HTML format HTML  |  1598620734 in plain Text format TXT  |  1598620734 in PDF (Portable Document Format) PDF  |  1598620734 in an XML format XML  formats.

NPI Number : 1598620734 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598620734",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DOMINO MED PHARMACY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5770 PLYMOUTH RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANN ARBOR",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48105-9312",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-669-1560",
    "MailingAddressFaxNumber": "734-669-1570",
    "FirstLinePracticeLocationAddress": "5770 PLYMOUTH RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ANN ARBOR",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48105-9312",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "734-669-1560",
    "PracticeLocationAddressFaxNumber": "734-669-1570",
    "EnumerationDate": "12/19/2025",
    "LastUpdateDate": "12/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TRAVIS",
    "AuthorizedOfficialFirstName": "JOHN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PHARMACIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "313-303-5084",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336C0003X",
        "TaxonomyName": "Community/Retail Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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