Active NPI
Mare Chris Deanne a Domingo, PHARMD
- Pharmacist
- Chicago, IL
National Provider Identifier
1144811373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051303406
- Practice address
- 2427 W Chicago Ave
Chicago, IL 60622-4631 - Phone
- (773) 342-6060
- NPI assigned
- Jan 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051303406 | IL | Primary |
Addresses
Primary practice location
2427 W Chicago Ave
Chicago, IL 60622-4631
Mailing address
2427 W Chicago Ave
Chicago, IL 60622-4631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051303406 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611964800000",
"number": "1144811373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2427 W CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606224631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2427 W CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606224631",
"telephone_number": "773-342-6060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGO",
"first_name": "MARE CHRIS",
"middle_name": "DEANNE A",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-30",
"last_updated": "2021-01-30",
"certification_date": "2021-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051303406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.