Provider Demographics
NPI:1992454383
Name:DDLJ ENTERPRISE, LLC
Entity type:Organization
Organization Name:DDLJ ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VANDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:717-503-2028
Mailing Address - Street 1:4821 LJ PKWY STE 60
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4987
Mailing Address - Country:US
Mailing Address - Phone:281-969-7346
Mailing Address - Fax:
Practice Address - Street 1:4821 LJ PKWY STE 60
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4987
Practice Address - Country:US
Practice Address - Phone:281-969-7346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy