Organization
340B PARTNERS PHARMACY - DALLAS LLC
Active
Other names
AVITA DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
CARL COLQUITT (CFO)
(469) 592-2005
Entity
Organization
Contact information
Practice address
750 FORT WORTH AVE STE H100, DALLAS, TX 75208-1811
(214) 943-5187
(972) 807-2657
Mailing address
411 COLONIAL DR, BATON ROUGE, LA 70806-6506
(214) 780-0898
(214) 780-0953
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
26681
TX
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146086
—
TX
01
—
4554641
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/14/2009
Last updated
10/07/2024
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