Provider Demographics
NPI:1063748812
Name:AFFINITY BIOTECH, INC
Entity type:Organization
Organization Name:AFFINITY BIOTECH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OR OPERATIONS, DIPLOMAT PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-768-9863
Mailing Address - Street 1:11303 CHIMNEY ROCK RD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-2901
Mailing Address - Country:US
Mailing Address - Phone:713-551-2090
Mailing Address - Fax:888-805-3450
Practice Address - Street 1:11303 CHIMNEY ROCK RD STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-2901
Practice Address - Country:US
Practice Address - Phone:713-551-2087
Practice Address - Fax:888-805-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X, 3336S0011X
TX268453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124498OtherPK