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General NPI Number Information
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NPI Number | 1851462873
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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 | 11/13/2006
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 6406 MCPHERSON RD STE 6
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City | LAREDO
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State | TX
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Zip | 78041-6258
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Country | US
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Telephone | 866-270-3226
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Fax | 888-959-5908
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Provider Business Mailing Address
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Address Line | 5700 GRANITE PARKWAY SUITE 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 | 469-592-2011
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | CARL CODY COLQUITT
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Credential |
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Telephone | 469-592-2011
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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 | 02258
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License Number State | TX
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Taxonomy #2
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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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