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General NPI Number Information
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NPI Number | 1831276948
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Entity Type | Organization
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Legal Business Name | ELBA MEDICAL DIST INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 5204 VETERANS BLVD
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City | METAIRIE
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State | LA
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Zip | 70006
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Country | US
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Telephone | 504-889-9654
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Fax | 504-889-6635
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Provider Business Mailing Address
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Address Line | 5208 VETERANS MEMORIAL BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-5123
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Country | US
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Telephone | 504-889-7070
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Fax | 504-889-7060
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Authorized Official
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Title or Position | VICE PRESIDENT DIRECTOR OF OPERATIO
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Name | MRS. DAISY G. DIMAGGIO
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Credential | RPH
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Telephone | 504-780-8455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 4360IR
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License Number State | LA
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