Provider Demographics
NPI:1689790610
Name:DOMINICK'S PHARMACY
Entity Type:Organization
Organization Name:DOMINICK'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DOROTA
Authorized Official - Middle Name:JANINA
Authorized Official - Last Name:JOZWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:630-681-1587
Mailing Address - Street 1:22W010 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-9755
Mailing Address - Country:US
Mailing Address - Phone:630-671-1458
Mailing Address - Fax:
Practice Address - Street 1:560 S SCHMALE RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2419
Practice Address - Country:US
Practice Address - Phone:630-681-1587
Practice Address - Fax:630-681-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy