Mark Dominique, PHARM.D, LCSW
Individual provider Active NPI Pharmacist · Hampden, ME
NPI 1831423201 · NPPES record last updated Jul 17, 2013
Key facts
- NPI
- 1831423201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PR6065 (ME)
- Practice address
- 65 Western Ave
Rite Aid
Hampden, ME 04444-1423 - Phone
- (207) 862-4900
- NPI assigned
- Oct 1, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR6065 | ME | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC12200 | ME | |
| Pharmacist | 183500000X | PR6065 | ME | Yes |
Addresses
Primary practice location
65 Western Ave
Rite Aid
Hampden, ME 04444-1423
Mailing address
65 Western Ave
Hampden, ME 04444-1423
Phone (207) 862-4900
Other providers in Hampden, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2013. 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.