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General NPI Number Information
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NPI Number | 1629589908
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Entity Type | Organization
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Legal Business Name | AV PHARMA LLC
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 1545 UNIVERSITY BLVD N STE C
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5229
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Country | US
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Telephone | 904-440-0611
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Fax | 904-323-4083
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Provider Business Mailing Address
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Address Line | PO BOX 600047
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City | JACKSONVILLE
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State | FL
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Zip | 32260-0047
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Country | US
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Telephone | 904-440-0611
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Fax | 904-323-4083
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | MR. VIPUL MAMTORA
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Credential |
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Telephone | 904-440-0611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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