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General NPI Number Information
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NPI Number | 1306522891
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Entity Type | Organization
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Legal Business Name | AVITA DRUGS LLC
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 600 PENNSYLVANIA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20003-4316
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Country | US
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Telephone | 202-978-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 GRANITE PKWY STE 425
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City | PLANO
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State | TX
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Zip | 75024-6648
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Country | US
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Telephone | 469-915-4843
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CARL CODY COLQUITT
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Credential |
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Telephone | 469-850-6930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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