Organization
PHARMBLUE LLC
Active
Other names
PharmBlue LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CFO)
(469) 592-2011
Entity
Organization
Contact information
Practice address
5700 GRANITE PKWY STE 425, PLANO, TX 75024-6648
(469) 592-2011
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
(469) 592-2011
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PP482599
PA
3336C0003X
Community/Retail Pharmacy
Primary
035289
NY
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028110910002
—
PA
01
—
2154646
PK
—
Enumeration date
10/07/2015
Last updated
06/27/2024
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