Organization
340B PARTNERS PHARMACY - DALLAS LLC
Active
Other names
Avita Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ELLIS (CORPORATE COUNSEL)
(803) 254-5884
Entity
Organization
Contact information
Practice address
750 FORT WORTH AVE STE H100, DALLAS, TX 75208-1811
(972) 805-5960
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816
(225) 924-1930
(225) 924-3217
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27717
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148897
—
TX
01
—
2131953
PK
—
Enumeration date
09/15/2011
Last updated
10/26/2020
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