Active NPI
Avita Drugs LLC
- Community/Retail Pharmacy
- Lafayette, LA
National Provider Identifier
1780333229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- AVITA DRUGS LLC
- Practice address
- 117 Caillouett PL Ste a
Lafayette, LA 70501-7807 - Phone
- (337) 443-7470
- NPI assigned
- Mar 22, 2022
- Organization subpart
- Yes
- Parent organization
- AVITA DRUGS LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Chad Brooker
- Title
- Senior Regulatory Counsel
- Phone
- (469) 592-2010
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
117 Caillouett PL Ste a
Lafayette, LA 70501-7807
Mailing address
10604 Coursey Blvd
Baton Rouge, LA 70816-4015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHY.008441-RC | Other | LA | BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241031000054 | LA | Part B Supplier - Pharmacy | 4789895129 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: New Orleans, LA; Lake Charles, LA; Lafayette, LA |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Avita Pharmacy
- Community/Retail Pharmacy
- New Orleans, LA
- NPI 1629435565
O20241031000054
-
dba Avita Pharmacy
- Community/Retail Pharmacy
- New Orleans, LA
- NPI 1043793029
O20241031000054
National Provider Directory
National Provider Directory- Tax ID family
- Avita Drugs LLC
- 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.
-
- Community/Retail Pharmacy
- Harahan, LA
- NPI 1710031166
Locations
117 Caillouett Pl
Ste A
Lafayette, LA 70501
Phone (337) 443-7470
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647907200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1647907200000",
"number": "1780333229",
"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": "117 CAILLOUETT PL STE A",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705017807",
"telephone_number": "337-443-7470"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVITA DRUGS LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AVITA DRUGS LLC",
"enumeration_date": "2022-03-22",
"last_updated": "2022-03-22",
"certification_date": "2022-03-22",
"status": "A",
"authorized_official_last_name": "BROOKER",
"authorized_official_first_name": "CHAD",
"authorized_official_title_or_position": "SENIOR REGULATORY COUNSEL",
"authorized_official_telephone_number": "469-592-2010"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHARMACY",
"identifier": "PHY.008441-RC",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.