MEDICARE: DR. DOMINIQUE MINJAREZ 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
1	183500000X	Pharmacist	18487	CO

General Provider Information

NPI Number	:	1326439720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIQUE MINJAREZ PHARMD

Provider Business Mailing Address
First Line	:	2615 EUDORA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3216
Country	:	US
Telephone Number	:	719-494-5684
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 EUDORA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3216
Country	:	US
Telephone Number	:	719-494-5684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2015
Last Update Date	:	02/07/2015

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