NPIMap

Organization Active NPI

Avita Drugs, LLC

Doing business as Avita Pharmacy 1068

  • Community/Retail Pharmacy
  • Abilene, TX
National Provider Identifier
1417529363
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
AVITA DRUGS, LLC
Doing business as
Avita Pharmacy 1068
Practice address
426 Butternut St Ste a
Abilene, TX 79602-1327
Phone
(325) 480-8989
Fax
(833) 866-0493
NPI assigned
Jul 12, 2021
Organization subpart
Yes
Parent organization
AVITA DRUGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Authorized official

Name
Chad Brooker, JD
Title
Regulatory Counsel
Phone
(469) 592-2010

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

426 Butternut St Ste a
Abilene, TX 79602-1327

Mailing address

5700 Granite Pkwy Ste 425
Plano, TX 75024-6648
Phone (469) 592-2010

Other names 1

  • Avita Pharmacy 1068 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Directory
Tax ID family
Avita Drugs LLC21 organizations share this tax ID, including this one
Part of
Avita Drugs LLC

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1417529363",
    "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",
            "telephone_number": "469-592-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 BUTTERNUT ST STE A",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796021327",
            "telephone_number": "325-480-8989",
            "fax_number": "833-866-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA DRUGS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVITA DRUGS, LLC",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "BROOKER",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "REGULATORY COUNSEL",
        "authorized_official_telephone_number": "469-592-2010",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy 1068",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Abilene, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.