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General NPI Number Information
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NPI Number | 1780234567
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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 | 09/13/2019
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 1715 COMMON ST STE A
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City | LAKE CHARLES
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State | LA
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Zip | 70601-6135
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Country | US
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Telephone | 337-429-2817
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Fax |
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Provider Business Mailing Address
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Address Line | 10604 COURSEY BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-4015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORPORATE COUBSEL
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Name | ASHLEY ELLIS
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Credential |
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Telephone | 803-254-5884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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