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General NPI Number Information
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NPI Number | 1699086447
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Entity Type | Organization
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Legal Business Name | DOMINYEMED CORPORATION
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Dates
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Enumeration Date | 06/27/2010
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 202 E AVE E
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City | ALPINE
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State | TX
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Zip | 79830
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Country | US
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Telephone | 432-837-2252
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Fax | 432-837-3152
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Provider Business Mailing Address
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Address Line | 202 E AVE E
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City | ALPINE
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State | TX
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Zip | 79830
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Country | US
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Telephone | 432-837-2252
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Fax | 432-837-3152
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MARIO X JUAREZ
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Credential | R.PH.
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Telephone | 432-336-2297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27226
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License Number State | TX
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