NPIMap

Organization Active NPI

Avita Drugs, LLC

Doing business as Avita Pharmacy 1085

  • Community/Retail Pharmacy
  • Chicago, IL
National Provider Identifier
1679363071
Registry record updated May 8, 2025
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 1085
Practice address
3635 N Halsted St
Chicago, IL 60613-4315
Phone
(872) 710-6132
NPI assigned
May 8, 2025
Last updated
May 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2025

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

Authorized official

Name
Kristen Gurley
Title
General Counsel
Phone
(469) 592-2011

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

3635 N Halsted St
Chicago, IL 60613-4315

Mailing address

5700 Granite Pkwy Ste 425
Plano, TX 75024-6648
Phone (469) 592-2011

Other names 1

  • Avita Pharmacy 1085 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251217000648 IL Part B Supplier - Pharmacy 4789895129 Practice locations: Chicago, IL

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Avita Drugs LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

3635 N Halsted St
Chicago, IL 60613
Phone (773) 472-6469

117 Caillouett Pl
Ste A
Lafayette, LA 70501
Phone (337) 443-7470

3308 Tulane Ave
Ste 102
New Orleans, LA 70119
Phone (504) 309-2557

426 Butternut St
Ste A
Abilene, TX 79602
Phone (325) 480-8989

3406 Bob Rogers Dr
Ste 220
Eagle Pass, TX 78852
Phone (830) 294-3264

2306 Camelot Plaza Cir
Ste B
Harlingen, TX 78550
Phone (956) 368-7870

300 S 2nd St
#103
McAllen, TX 78501
Phone (956) 365-2275

722 Isom Rd
Ste 103
San Antonio, TX 78216
Phone (726) 223-4500

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1746662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746662400000",
    "number": "1679363071",
    "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": "469-592-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 N HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606134315",
            "telephone_number": "872-710-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA DRUGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-08",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A",
        "authorized_official_last_name": "GURLEY",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "469-592-2011"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy 1085",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; 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.