Provider Demographics
NPI:1396222527
Name:NUTRITION RXD LLC
Entity Type:Organization
Organization Name:NUTRITION RXD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED DELEGATE
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-473-2455
Mailing Address - Street 1:121 KERRY'S POINTE
Mailing Address - Street 2:
Mailing Address - City:DES ALLEMANDS
Mailing Address - State:LA
Mailing Address - Zip Code:70030
Mailing Address - Country:US
Mailing Address - Phone:985-306-9003
Mailing Address - Fax:
Practice Address - Street 1:737 PAUL MAILLARD ROAD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070
Practice Address - Country:US
Practice Address - Phone:985-306-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2359133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty