Avita Drugs Mississippi, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

AVITA DRUGS MISSISSIPPI, LLC

Doing business as

Avita Pharmacy

Practice address

805 E River PL Ste a
Jackson, MS 39202-3486

Phone

(601) 336-1760

NPI assigned

Jun 6, 2019

Last updated

Jun 6, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ashley Ellis

Title

Corporate Counsel

Phone

(803) 254-5884

Specialties & licenses 1

Addresses

Other names 1

• Avita Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Miriah White, PHARMD.

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Ridgeland, MS
  • NPI 1275271033
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559779200000",
    "number": "1013576826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10604 COURSEY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708164015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 E RIVER PL STE A",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392023486",
            "telephone_number": "601-336-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA DRUGS MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-06",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CORPORATE COUNSEL",
        "authorized_official_telephone_number": "803-254-5884"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ebony Avant, PMHNP-BC
• Ryan Averill
• Gail T Avery, LPC
• Kara M Avery
• Avis Caring Hands Home Service
• Ramachandram Avusula
• Henna Awan
• Abigail Mallah Awode
• Axon
• Muhammad Ahmed Ayaz, MBBS

• Community/Retail Pharmacy in Jackson, MS
• Providers in Jackson, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.