Provider Demographics
NPI:1912537127
Name:FAMILY PHARMACY AT LAS COLINAS LLC
Entity Type:Organization
Organization Name:FAMILY PHARMACY AT LAS COLINAS LLC
Other - Org Name:FAMILY PHARMACY AT LAS COLINAS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-579-3230
Mailing Address - Street 1:6555 NORTH STATE HWY 161
Mailing Address - Street 2:SUITE B
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:972-830-3600
Mailing Address - Fax:972-830-3610
Practice Address - Street 1:6555 NORTH STATE HWY 161
Practice Address - Street 2:SUITE B
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039
Practice Address - Country:US
Practice Address - Phone:972-830-3600
Practice Address - Fax:972-830-3610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HONEYBEE BRIDGE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150304Medicaid