Provider Demographics
NPI:1447842638
Name:DOMINGUEZ, YUDANIA (PHARM D)
Entity type:Individual
Prefix:
First Name:YUDANIA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6233
Mailing Address - Country:US
Mailing Address - Phone:786-356-1583
Mailing Address - Fax:
Practice Address - Street 1:8600 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6202
Practice Address - Country:US
Practice Address - Phone:786-356-1583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist