Cassidy Louise Domagalla

Primary specialty

Geriatric PharmacistTaxonomy code 1835G0303X

License

051.296273 Issued in IL

Practice address

126 Oak St
Peoria, IL 61602-1639

Phone

(309) 690-7790

Fax

(866) 385-4948

NPI assigned

Mar 30, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Critical Care RX, LLC

  • Long Term Care Pharmacy
  • Peoria, IL
  • NPI 1720574676
  NPD (past)

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

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1386222685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 NORMAL AVE",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617611531",
            "telephone_number": "708-516-4718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 OAK ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021639",
            "telephone_number": "309-690-7790",
            "fax_number": "866-385-4948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMAGALLA",
        "first_name": "CASSIDY",
        "middle_name": "LOUISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "IL",
            "license": "051.296273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "051.296273",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dolan Central Illinois Compounding LLC
• Dolan Central Illinois Compounding Pharmacy LLC
• Shannon Dolan
• Tonia Dolan
• Pamela Doloszycki, APN
• Matthew David Domico, MSW, LCSW
• Sarah E Dominique, APN CDE
• Jerome Taymon Domzalski, MD
• Janine E. Donahue, M.D.
• Kathleen Donahue

• Geriatric Pharmacist in Peoria, IL
• Providers in Peoria, IL by specialty
• Geriatric Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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.

Verify at the official NPI Registry.