Provider Demographics
NPI:1255631966
Name:DOMINICK'S PHARMACY
Entity type:Organization
Organization Name:DOMINICK'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MING
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:847-776-1386
Mailing Address - Street 1:615 E DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2817
Mailing Address - Country:US
Mailing Address - Phone:847-776-1386
Mailing Address - Fax:
Practice Address - Street 1:615 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2817
Practice Address - Country:US
Practice Address - Phone:847-776-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty