Amanda Sims Dominguez, PHARM D.
Individual provider Active NPI Pharmacist · Stonewall, LA
NPI 1023419785 · NPPES record last updated Dec 13, 2016
Key facts
- NPI
- 1023419785
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 019390 (LA)
- Practice address
- 4974 Highway 3276 Ste B
Stonewall, LA 71078-9335 - Phone
- (318) 775-4371
- Fax
- (318) 775-7369
- NPI assigned
- Sep 11, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019390 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NDD LLC | Current | Accepting new patients |
Locations
4974 Highway 3276
Ste B
Stonewall, LA 71078
Phone (318) 681-4344
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 019390 | LA | Yes |
Addresses
Primary practice location
4974 Highway 3276 Ste B
Stonewall, LA 71078-9335
Mailing address
4974 Highway 3276 Ste B
Stonewall, LA 71078-9335
Phone (318) 775-4371
Other providers in Stonewall, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.