Healthcare Provider Details

I. General information

NPI: 1710031166
Provider Name (Legal Business Name): AVITA DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 JEFFERSON HWY STE G
HARAHAN LA
70123-5153
US

IV. Provider business mailing address

6226 JEFFERSON HWY STE G
HARAHAN LA
70123-5153
US

V. Phone/Fax

Practice location:
  • Phone: 504-737-4007
  • Fax: 504-737-4008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6048IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE MOUBRY
Title or Position: VP OF FINANCE
Credential:
Phone: 504-737-4007