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Contact Information

MARK DOMINIQUE, PHARM.D, LCSW
65 WESTERN AVE
RITE AID
HAMPDEN, ME04444-1423
 Phone: 207-862-4900
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacist

183500000X
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for MARK DOMINIQUE · (Male)

NPI # 1831423201
Status Active
Credentials PHARM.D, LCSW
Entity Individual
Enumeration date 10/01/2009
Last updated 07/17/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • ME License # LC12200
  • ME License # PR6065
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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