340B Partners Pharmacy - Dallas LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

26681 Issued in TX

Legal business name

340B PARTNERS PHARMACY - DALLAS LLC

Doing business as

Avita Drugs

Practice address

750 Fort Worth Ave Ste H100
Dallas, TX 75208-1811

Phone

(214) 943-5187

Fax

(972) 807-2657

NPI assigned

Dec 14, 2009

Last updated

Oct 7, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carl Colquitt

Title

Cfo

Phone

(469) 592-2005

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• AVITA DRUGS Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Avita Drugs LLC

  dba Avita Pharmacy

  • Community/Retail Pharmacy
  • Bellaire, TX
  • NPI 1538526470

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1790014124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 COLONIAL DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708066506",
            "telephone_number": "214-780-0898",
            "fax_number": "214-780-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 FORT WORTH AVE STE H100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752081811",
            "telephone_number": "214-943-5187",
            "fax_number": "972-807-2657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "340B PARTNERS PHARMACY - DALLAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-14",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "COLQUITT",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "469-592-2005"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "26681",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146086",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4554641",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVITA DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.