Provider Demographics
NPI:1346812286
Name:AVITA DRUGS, LLC
Entity Type:Organization
Organization Name:AVITA DRUGS, LLC
Other - Org Name:AVITA PHARMACY 1035
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGULATORY COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-592-2010
Mailing Address - Street 1:5700 GRANITE PKWY STE 425
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6648
Mailing Address - Country:US
Mailing Address - Phone:469-592-2010
Mailing Address - Fax:
Practice Address - Street 1:101 W KOENIG LN STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1213
Practice Address - Country:US
Practice Address - Phone:512-394-3101
Practice Address - Fax:833-777-0237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVITA DRUGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-12
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy