Active NPI
Avita Drugs, LLC
- Community/Retail Pharmacy
- San Antonio, TX
National Provider Identifier
1295888949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 01935
- Legal business name
- AVITA DRUGS, LLC
- Practice address
- 2602 N Main Ave
San Antonio, TX 78212-2919 - Phone
- (210) 736-3161
- Fax
- (210) 736-3175
- NPI assigned
- Jan 18, 2007
- 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) 592-2011
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 01935 | TX | Primary |
Addresses
Primary practice location
2602 N Main Ave
San Antonio, TX 78212-2919
Mailing address
5700 Granite Parkway
Suite 425
Plano, TX 75024-6648
Phone (469) 592-2011
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130275 | Medicaid | TX |
Other names 1
- Avita Pharmacy 1077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230427000457 | TX | Part B Supplier - Pharmacy | 4789895129 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Austin, TX; Abilene, TX; San Antonio, TX; Harlingen, TX; Eagle Pass, TX; Bellaire, TX; McAllen, TX |
Other NPIs on the same Medicare enrollment 9
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Irving, TX
- NPI 1699102699
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1706659200000",
"number": "1295888949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5700 GRANITE PARKWAY",
"address_2": "SUITE 425",
"city": "PLANO",
"state": "TX",
"postal_code": "750246648",
"telephone_number": "469-592-2011",
"fax_number": "210-736-3175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2602 N MAIN AVE",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782122919",
"telephone_number": "210-736-3161",
"fax_number": "210-736-3175"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVITA DRUGS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-18",
"last_updated": "2024-01-31",
"certification_date": "2024-01-31",
"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": "469-592-2011"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "01935",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "130275",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Avita Pharmacy 1077",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.