340B Partners Pharmacy - Dallas LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

340B PARTNERS PHARMACY - DALLAS LLC

Doing business as

Avita Pharmacy

Practice address

2800 S Ih 35 Frontage Rd
Suite 105
Austin, TX 78704

Phone

(512) 213-4030

NPI assigned

Oct 12, 2020

Last updated

Oct 12, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

AVITA DRUGS, LLCAs reported in NPPES

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

Authorized official

Name

Ashley Ellis

Title

Corporate Counsel

Phone

(803) 254-5884

Specialties & licenses 1

Addresses

Other names 1

• Avita Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• 340B Partners Pharmacy - Dallas LLC

  dba Avita Drugs

  • Community/Retail Pharmacy
  • Dallas, TX
  • NPI 1962784900

  7416130166

  Same PAC ID

Tax ID family

340B Partners Pharmacy - Dallas LLC2 organizations share this tax ID, including this one

Part of

Avita Drugs LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 340B Partners Pharmacy - Dallas LLC

  dba Avita Drugs

  • Community/Retail Pharmacy
  • Dallas, TX
  • NPI 1962784900
  NPD tax ID

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": "1602460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602460800000",
    "number": "1801494018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10604 COURSEY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708164015",
            "telephone_number": "225-236-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 S IH 35 FRONTAGE RD",
            "address_2": "SUITE 105",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78704",
            "telephone_number": "512-213-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "340B PARTNERS PHARMACY - DALLAS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVITA DRUGS, LLC",
        "enumeration_date": "2020-10-12",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CORPORATE COUNSEL",
        "authorized_official_telephone_number": "803-254-5884"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Austin, TX
• Providers in Austin, 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 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.