Active NPI
Avita Drugs Alabama LLC
- Community/Retail Pharmacy
- Dothan, AL
National Provider Identifier
1124854674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- AVITA DRUGS ALABAMA LLC
- Practice address
- 1891 Honeysuckle Rd Ste 3
Dothan, AL 36305-4291 - Phone
- (334) 679-7940
- NPI assigned
- Sep 11, 2024
- Last updated
- Sep 11, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Carl Cody Colquitt
- Title
- Chief Financial Officer
- Phone
- (469) 850-6930
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
1891 Honeysuckle Rd Ste 3
Dothan, AL 36305-4291
Mailing address
5700 Granite Pkwy Ste 425
Plano, TX 75024-6648
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230622003338 | AL | Part B Supplier - Pharmacy | 9830557883 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Birmingham, AL; Dothan, AL; Montgomery, AL |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Avita Pharmacy
- Community/Retail Pharmacy
- Birmingham, AL
- NPI 1275184517
O20230622003338
-
dba Avita Pharmacy 1079
- Community/Retail Pharmacy
- Montgomery, AL
- NPI 1679277024
O20230622003338
National Provider Directory
National Provider Directory- Tax ID family
- Avita Drugs Alabama LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Avita Pharmacy 1079
- Community/Retail Pharmacy
- Montgomery, AL
- NPI 1679277024
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726012800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1726012800000",
"number": "1124854674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5700 GRANITE PKWY STE 425",
"city": "PLANO",
"state": "TX",
"postal_code": "750246648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1891 HONEYSUCKLE RD STE 3",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363054291",
"telephone_number": "334-679-7940"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVITA DRUGS ALABAMA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-09-11",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A",
"authorized_official_last_name": "COLQUITT",
"authorized_official_first_name": "CARL",
"authorized_official_middle_name": "CODY",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "469-850-6930"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
- Bailey Baumann Atwell, BEHAVIOR ANALYST
- Aurora Counseling, LLC
- Hillary Patterson Austin, BCBA
- Kimberly Danielle Austin, M.ED, CCC-SLP
- Pamela Susan Averett, CRNA
- Sai Avula, M.D.
- Djuliana Ayazifar, MD
- Quintory Ziyanna Ja'Quay Ayers
- Mohammed Tashfiqul Azam
- B&W Medical Solutions LLC (Southern Lux and Metabolic Wellness)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.