Provider Demographics
NPI:1255732012
Name:NDD LLC
Entity type:Organization
Organization Name:NDD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-775-4371
Mailing Address - Street 1:316 PLANTATION HILLS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-2838
Mailing Address - Country:US
Mailing Address - Phone:318-775-4371
Mailing Address - Fax:318-775-4369
Practice Address - Street 1:316 PLANTATION HILLS BLVD STE A
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-2838
Practice Address - Country:US
Practice Address - Phone:318-775-4371
Practice Address - Fax:318-775-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
LAPHY.006948-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147912OtherPK
LA2203061Medicaid