Healthcare Provider Details

I. General information

NPI: 1275919086
Provider Name (Legal Business Name): AVNI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 BACK ACRE CIR STE 190-B
MOUNT AIRY MD
21771-7769
US

IV. Provider business mailing address

2702 BACK ACRE CIR SUITE 190-B
MOUNT AIRY MD
21771-7769
US

V. Phone/Fax

Practice location:
  • Phone: 301-703-8836
  • Fax: 301-703-8876
Mailing address:
  • Phone: 301-703-8836
  • Fax: 301-703-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06847
License Number StateMD

VIII. Authorized Official

Name: KIMBERLY LIZARDO
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 301-703-8836