Provider Demographics
NPI:1396733986
Name:DIDOMENICO, DON M (RPH, CDM)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:M
Last Name:DIDOMENICO
Suffix:
Gender:M
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4150
Mailing Address - Country:US
Mailing Address - Phone:303-750-8346
Mailing Address - Fax:303-750-8349
Practice Address - Street 1:1200 S BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4150
Practice Address - Country:US
Practice Address - Phone:303-750-8342
Practice Address - Fax:303-750-8349
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist