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NPI Code Detail

MEDICARE: DR. MARE CHRIS DEANNE A DOMINGO PHARMD

MEDICARE: DR. MARE CHRIS DEANNE A DOMINGO PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051303406IL

General Provider Information

NPI Number : 1144811373
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARE CHRIS DEANNE A DOMINGO PHARMD
Provider Business Mailing Address
First Line : 2427 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2427 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4631
Country : US
Telephone Number : 773-342-6060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2021
Last Update Date : 01/30/2021

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