Provider Demographics
NPI:1285711390
Name:ELBA MEDICAL DISTRIBUTORS INC
Entity type:Organization
Organization Name:ELBA MEDICAL DISTRIBUTORS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT DIRECTOR OF OPERATIO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIMAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-780-8455
Mailing Address - Street 1:5208 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-889-7070
Mailing Address - Fax:504-889-7060
Practice Address - Street 1:5208 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-889-7070
Practice Address - Fax:504-889-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2670IR3336C0003X, 3336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-24681OtherNCPDP NUMBER
LA5CY65OtherMEDICARE/PART B PTAN
LA1260932Medicaid
LA19-24681OtherNCPDP NUMBER