MEDICARE: 340B PARTNERS PHARMACY - DALLAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy	26681	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4554641	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1790014124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	340B PARTNERS PHARMACY - DALLAS LLC

Provider Business Mailing Address
First Line	:	411 COLONIAL DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6506
Country	:	US
Telephone Number	:	214-780-0898
Fax Number	:	214-780-0953

Provider Business Practice Location Address
First Line	:	750 FORT WORTH AVE STE H100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1811
Country	:	US
Telephone Number	:	214-943-5187
Fax Number	:	972-807-2657

Authorized Official
Title or Position	:	CFO
Name	:	CARL COLQUITT
Credential	:
Telephone Number	:	469-592-2005

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	10/07/2024

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