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General NPI Number Information
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NPI Number | 1780055434
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Entity Type | Organization
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Legal Business Name | PHARMBLUE LLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 5700 GRANITE PKWY STE 425
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City | PLANO
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State | TX
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Zip | 75024-6648
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Country | US
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Telephone | 469-592-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 10604 COURSEY BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-4015
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Country | US
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Telephone | 469-592-2011
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CARL CODY COLQUITT
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Credential |
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Telephone | 469-592-2011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP482599
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 035289
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License Number State | NY
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