Active NPI
340B Partners Pharmacy - Dallas LLC
Doing business as Avita Drugs
- Community/Retail Pharmacy
- Dallas, TX
National Provider Identifier
1962784900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 27717
- 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
- (972) 805-5960
- NPI assigned
- Sep 15, 2011
- Last updated
- Oct 26, 2020
- Organization subpart
- No
NPPES NPI Registry
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 27717 | TX | Primary |
Addresses
Primary practice location
750 Fort Worth Ave Ste H100
Dallas, TX 75208-1811
Mailing address
10604 Coursey Blvd
Baton Rouge, LA 70816
Phone (225) 924-1930
Other practice location 1
219 Sunset Ave Ste 118A
Dallas, TX 75208-4500
Phone (214) 943-5187
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2131953 | Other | PK | |
| 148897 | Medicaid | TX |
Other names 1
- Avita Drugs
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120402000692 | TX | DME Supplier - Pharmacy | 7416130166 | Practice locations: Dallas, TX |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Avita Pharmacy
- Community/Retail Pharmacy
- Austin, TX
- NPI 1801494018
7416130166
National Provider Directory
National Provider Directory- Tax ID family
- 340B Partners Pharmacy - Dallas LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Avita Pharmacy
- Community/Retail Pharmacy
- Austin, TX
- NPI 1801494018
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
219 Sunset Ave
Ste 118A
Dallas, TX 75208
Phone (214) 943-5187
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Dallas, TX
- NPI 1811343205
-
- Pharmacist
- Dallas, TX
- NPI 1407995525
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316044800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1603670400000",
"number": "1962784900",
"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": "70816",
"telephone_number": "225-924-1930",
"fax_number": "225-924-3217"
},
{
"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": "972-805-5960"
}
],
"practiceLocations": [
{
"address_1": "219 Sunset Ave Ste 118A",
"address_purpose": "LOCATION",
"city": "Dallas",
"state": "TX",
"postal_code": "752084500",
"country_code": "US",
"telephone_number": "214-943-5187",
"fax_number": "972-807-2657",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "340B PARTNERS PHARMACY - DALLAS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-09-15",
"last_updated": "2020-10-26",
"certification_date": "2020-10-26",
"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": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "27717",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2131953",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "148897",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Avita Drugs",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Avita Drugs",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dallas, TX
- 24-7 Shalom Psychiatry PLLC
- 24/7 Services,Inc (Davisson Behavioral and Social Ser)
- 2ND Chances Family Services
- 3 Angels Caregivers
- 340B Partners Pharmacy - Dallas LLC (Avita Drugs)
- 360 Anesthesia, PA
- 360 Counseling & Wellness, PLLC (360 Counseling and Wellness, PLLC)
- 3DPT, PLLC (3DPT)
- 3Rd Gen Bond Enterprises, LLC
- 424 Rehab
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.