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NPI Code Detail

MEDICARE: AVITA DRUGS, LLC

MEDICARE: AVITA DRUGS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336S0011XSpecialty Pharmacy
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1346812286
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVITA DRUGS, LLC
Provider Business Mailing Address
First Line : 5700 GRANITE PKWY STE 425
Second Line :
City : PLANO
State : TX
Zip : 75024-6648
Country : US
Telephone Number : 469-592-2010
Fax Number :
Provider Business Practice Location Address
First Line : 101 W KOENIG LN STE 400
Second Line :
City : AUSTIN
State : TX
Zip : 78751-1213
Country : US
Telephone Number : 512-394-3101
Fax Number : 833-777-0237
Authorized Official
Title or Position : REGULATORY COUNSEL
Name : CHAD BROOKER
Credential :
Telephone Number : 469-592-2010
Provider Enumeration Date : 07/12/2021
Last Update Date : 03/01/2022

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Directions to “AVITA DRUGS, LLC ” Practice Location

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