Provider Demographics
NPI:1316645450
Name:DOMINUS RX LLC
Entity type:Organization
Organization Name:DOMINUS RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KLEBER
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-649-0180
Mailing Address - Street 1:740 NEW LOTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-7319
Mailing Address - Country:US
Mailing Address - Phone:718-649-0180
Mailing Address - Fax:718-649-2720
Practice Address - Street 1:740 NEW LOTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-7319
Practice Address - Country:US
Practice Address - Phone:718-649-0180
Practice Address - Fax:718-649-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy