Provider Demographics
NPI:1023493012
Name:DOMINIC, MARIA TEMILOLA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TEMILOLA
Last Name:DOMINIC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 UNICORN LAKE BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0169
Mailing Address - Country:US
Mailing Address - Phone:940-226-4849
Mailing Address - Fax:
Practice Address - Street 1:3303 UNICORN LAKE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0169
Practice Address - Country:US
Practice Address - Phone:940-226-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist