Provider Demographics
NPI:1922387869
Name:DOMINGO, JOVENCIO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOVENCIO
Middle Name:
Last Name:DOMINGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 E TAPATIO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1187
Mailing Address - Country:US
Mailing Address - Phone:602-369-0577
Mailing Address - Fax:
Practice Address - Street 1:8245 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-4722
Practice Address - Country:US
Practice Address - Phone:623-849-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013244183500000X
OR10747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist