NPIMap

Organization Active NPI

Avita Drugs LLC

Doing business as Avita Pharmacy

  • Pharmacy
  • Lake Charles, LA
National Provider Identifier
1780234567
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
AVITA DRUGS LLC
Doing business as
Avita Pharmacy
Practice address
1715 Common St Ste a
Lake Charles, LA 70601-6135
Phone
(337) 429-2817
NPI assigned
Sep 13, 2019
Last updated
Feb 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

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

Authorized official

Name
Ashley Ellis
Title
Corporate Coubsel
Phone
(803) 254-5884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

1715 Common St Ste a
Lake Charles, LA 70601-6135

Mailing address

10604 Coursey Blvd
Baton Rouge, LA 70816-4015

Other names 1

  • Avita Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241031000054 LA Part B Supplier - Pharmacy 4789895129 3 other NPIs on this enrollment
Practice locations: New Orleans, LA; Lake Charles, LA; Lafayette, LA

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

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

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": "1568332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1780234567",
    "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": "1715 COMMON ST STE A",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706016135",
            "telephone_number": "337-429-2817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA DRUGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-13",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CORPORATE COUBSEL",
        "authorized_official_telephone_number": "803-254-5884"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avita Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; 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.