Provider Demographics
NPI:1306860960
Name:DOMINGUEZ, LILLIAM MARIA (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAM
Middle Name:MARIA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 CALLE SAMARIA
Mailing Address - Street 2:URB VILLA DEL CARMEN
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2129
Mailing Address - Country:US
Mailing Address - Phone:787-873-1480
Mailing Address - Fax:787-873-1480
Practice Address - Street 1:225 CALLE MARGINAL
Practice Address - Street 2:SUITE 2 BO MAGINA
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-3004
Practice Address - Country:US
Practice Address - Phone:787-873-1480
Practice Address - Fax:787-873-1480
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2866183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician