Provider Demographics
NPI:1619575362
Name:AVA HEALTHCARE LLC
Entity Type:Organization
Organization Name:AVA HEALTHCARE LLC
Other - Org Name:CAREFIRST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-247-3881
Mailing Address - Street 1:1600 W LOUISIANA ST STE 700
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7881
Mailing Address - Country:US
Mailing Address - Phone:214-842-8445
Mailing Address - Fax:214-842-8223
Practice Address - Street 1:1600 W LOUISIANA ST STE 700
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7881
Practice Address - Country:US
Practice Address - Phone:214-842-8445
Practice Address - Fax:214-842-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2193207OtherPK
TX150379Medicaid