Avita Drugs Tennessee, LLC
Organization Active NPI Community/Retail Pharmacy · Nashville, TN
NPI 1003488495 · NPPES record last updated Jul 14, 2021
Key facts
- NPI
- 1003488495
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- AVITA DRUGS TENNESSEE, LLC
- Practice address
- 1005 Dr. B. Todd Jr. Blvd
Suite 332
Nashville, TN 37208 - Phone
- (321) 369-9495
- NPI assigned
- Jul 14, 2021
- Organization subpart
- No
Authorized official
- Name
- Ryan Boyle
- Title
- Regulatory Counsel
- Phone
- (225) 236-1538
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231005002792 | TN | Part B Supplier - Pharmacy | 4587019872 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Nashville, TN |
National Provider Directory
- Tax ID family
- Avita Drugs Tennessee LLC
Locations
501 28th Ave N
Ste A
Nashville, TN 37209
Phone (225) 236-0204
1005 Dr Db Todd Jr Blvd
Ste 332
Nashville, TN 37208
Phone (321) 369-9495
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1005 Dr. B. Todd Jr. Blvd
Suite 332
Nashville, TN 37208
Mailing address
10604 Coursey Blvd
Baton Rouge, LA 70816-4015
Phone (225) 236-1541
Other names
- Avita Pharmacy 1065
Other providers in Nashville, TN
- Elizabeth Averill
- Olivia Jane Averitt
- Andrew Avery
- Jefersson Avila
- Katelin Taylor Avila
- Avita Drugs Tennessee, LLC
- Avita Drugs Tennessee, LLC
- Ila Mae Avitia
- Lauren Madison Avritt
- Avw, PLLC
All providers in Nashville, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.