NPIMap

Organization Active NPI

Dominguez Pharmacy LP

  • Community/Retail Pharmacy
  • Upland, CA
National Provider Identifier
1285728683
Registry record updated Jul 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
49930 Issued in CA
Legal business name
DOMINGUEZ PHARMACY LP
Practice address
1175 E Arrow Hwy
Upland, CA 91786-5525
Phone
(909) 981-1009
Fax
(909) 981-3612
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andres Dominguez, PHARM D
Title
General Partner
Phone
(951) 707-5095

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 49930 CA Primary

Addresses

Primary practice location

1175 E Arrow Hwy
Upland, CA 91786-5525

Mailing address

949 Talcey Ter
Riverside, CA 92506-7517
Phone (951) 707-5095

Other identifiers 2

IdentifierTypeStateIssuer
1285728683MedicaidCA
2120719OtherPK

Other names 1

  • MEDICAL ARTS PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dominguez Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374105600000",
    "number": "1285728683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 TALCEY TER",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925067517",
            "telephone_number": "951-707-5095",
            "fax_number": "951-780-1685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 E ARROW HWY",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865525",
            "telephone_number": "909-981-1009",
            "fax_number": "909-981-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINGUEZ PHARMACY LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-07-18",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "951-707-5095",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "49930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285728683",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120719",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL ARTS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.