Healthcare Provider Details

I. General information

NPI: 1255732012
Provider Name (Legal Business Name): NDD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PLANTATION HILLS BLVD STE A
STONEWALL LA
71078-2838
US

IV. Provider business mailing address

316 PLANTATION HILLS BLVD STE A
STONEWALL LA
71078-2838
US

V. Phone/Fax

Practice location:
  • Phone: 318-775-4371
  • Fax: 318-775-4369
Mailing address:
  • Phone: 318-775-4371
  • Fax: 318-775-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.006948-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DOMINGUEZ
Title or Position: OWNER
Credential:
Phone: 318-775-4371