Provider Demographics
NPI:1679693410
Name:DOMINICKS
Entity type:Organization
Organization Name:DOMINICKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-372-9015
Mailing Address - Street 1:1041 W STEARNS RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4509
Mailing Address - Country:US
Mailing Address - Phone:630-372-9015
Mailing Address - Fax:630-372-9136
Practice Address - Street 1:1041 W STEARNS RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4509
Practice Address - Country:US
Practice Address - Phone:630-372-9015
Practice Address - Fax:630-372-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty