Provider Demographics
NPI:1174013015
Name:DOMINGUEZ, ENRIQUE (RPH)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2622
Mailing Address - Country:US
Mailing Address - Phone:806-763-9999
Mailing Address - Fax:
Practice Address - Street 1:1610 5TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2622
Practice Address - Country:US
Practice Address - Phone:806-763-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist