Healthcare Provider Details

I. General information

NPI: 1649930868
Provider Name (Legal Business Name): AVA RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 SPRINGFIELD RD STE F
AVA MO
65608-5477
US

IV. Provider business mailing address

PO BOX 1809
AVA MO
65608-1809
US

V. Phone/Fax

Practice location:
  • Phone: 417-683-9550
  • Fax: 417-250-8002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATIE LUCKFIELD
Title or Position: PIC
Credential: PHARM D
Phone: 417-813-5077