Provider Demographics
NPI:1417529363
Name:AVITA DRUGS, LLC
Entity Type:Organization
Organization Name:AVITA DRUGS, LLC
Other - Org Name:
Other - Org Type:
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:JD
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 1:426 BUTTERNUT ST STE A
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1327
Practice Address - Country:US
Practice Address - Phone:325-480-8989
Practice Address - Fax:833-866-0493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVITA DRUGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy