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NPI Code Detail

MEDICARE: ASHLEY DOMINO

MEDICARE: ASHLEY DOMINO
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
1183500000XPharmacist65275TX

General Provider Information

NPI Number : 1801408760
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY DOMINO
Provider Business Mailing Address
First Line : 4515 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-3836
Country : US
Telephone Number : 817-735-8185
Fax Number :
Provider Business Practice Location Address
First Line : 4515 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-3836
Country : US
Telephone Number : 817-735-8185
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2020
Last Update Date : 08/20/2020

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Directions to “ ASHLEY DOMINO ” Practice Location

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