NPIMap

Organization Active NPI

Avita Drugs, LLC

  • Community/Retail Pharmacy
  • Laredo, TX
National Provider Identifier
1851462873
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
AVITA DRUGS, LLC
Practice address
6406 McPherson Rd Ste 6
Laredo, TX 78041-6258
Phone
(866) 270-3226
Fax
(888) 959-5908
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 02258 TX
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

6406 McPherson Rd Ste 6
Laredo, TX 78041-6258

Mailing address

5700 Granite Parkway
Suite 425
Plano, TX 75024-6648
Phone (469) 592-2011

Other identifiers 2

IdentifierTypeStateIssuer
146631MedicaidTX
4504608OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • Avita Pharmacy 1076 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

Other organizations with this tax ID 20

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

View all 20

Locations

6406 McPherson Rd
Ste 6
Laredo, TX 78041
Phone (866) 270-3226

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1851462873",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6406 MCPHERSON RD STE 6",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416258",
            "telephone_number": "866-270-3226",
            "fax_number": "888-959-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA DRUGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "02258",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146631",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4504608",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy 1076",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laredo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.

Verify at the official NPI Registry.