NPIViewer - Provider NPI 1386984771

NPI:	1386984771
Name:	PHARMBLUE LLC
Entity type:	Organization
Organization Name:	PHARMBLUE LLC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:	CARL
Authorized Official - Middle Name:	CODY
Authorized Official - Last Name:	COLQUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	469-850-6930
Mailing Address - Street 1:	10604 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:	BATON ROUGE
Mailing Address - State:	LA
Mailing Address - Zip Code:	70816-4015
Mailing Address - Country:	US
Mailing Address - Phone:	469-592-2011
Mailing Address - Fax:
Practice Address - Street 1:	1226 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:	PHILADELPHIA
Practice Address - State:	PA
Practice Address - Zip Code:	19107-4849
Practice Address - Country:	US
Practice Address - Phone:	855-779-4720
Practice Address - Fax:	558-779-4721
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2013-02-21
Last Update Date:	2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

State	Identifier ID	ID Type	Issuer
MN	1386984771	Medicaid
NH	3096207	Medicaid
VA	1386984771	Medicaid
NM	48076554	Medicaid
NE	10026562700	Medicaid
MT	1386984771	Medicaid
	2139860	Other	PK
TN	1386984771	Medicaid
OR	500689502	Medicaid
SC	7P2344	Medicaid
DC	82828501	Medicaid
PA	102811091 0001	Medicaid
WA	1386984771	Medicaid
OH	152103	Medicaid
MD	70409100	Medicaid