Tina Marie Dominy, RPH
Individual provider Active NPI Pharmacist · Peru, IL
NPI 1275133787 · NPPES record last updated Oct 26, 2020
Key facts
- NPI
- 1275133787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051036977 (IL)
- Practice address
- 5307 State Route 251
Peru, IL 61354-9313 - Phone
- (815) 224-1508
- Fax
- (815) 224-8003
- NPI assigned
- Oct 26, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051036977 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051036977 | IL | Yes |
Addresses
Primary practice location
5307 State Route 251
Peru, IL 61354-9313
Mailing address
5307 State Route 251
Peru, IL 61354-9313
Phone (815) 224-1508
Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.