Provider Demographics
NPI:1003948316
Name:DOMINGUEZ, BENIGNO (RPH)
Entity type:Individual
Prefix:
First Name:BENIGNO
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:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1295
Mailing Address - Country:US
Mailing Address - Phone:787-745-4381
Mailing Address - Fax:787-258-1140
Practice Address - Street 1:CARR #1 KM 34.0 REPARTO IND. CARTAGENA
Practice Address - Street 2:BOX 368
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-653-0951
Practice Address - Fax:787-744-4898
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4145183500000X
FLPS27430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist