Provider Demographics
NPI:1194101204
Name:DMD VENTURES
Entity type:Organization
Organization Name:DMD VENTURES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:CERNIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:504-835-6060
Mailing Address - Street 1:1107 VETERANS MEMORIAL BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2748
Mailing Address - Country:US
Mailing Address - Phone:504-835-6060
Mailing Address - Fax:504-835-0330
Practice Address - Street 1:1107 VETERANS BLVD
Practice Address - Street 2:STE 3
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2748
Practice Address - Country:US
Practice Address - Phone:504-835-6060
Practice Address - Fax:504-835-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2204041Medicaid
LA1938743OtherNABP
LAPHY.007194-IROtherLABOP