| NPI | 1053357509 |
|---|---|
| Doing Business As | AVITA PHARMACY 1046 |
| Entity Type | Organization |
| Authorized Contact | CARL CODY COLQUITT Chief Financial Officer 469-592-2011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA PHRE009702) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2023-12-11 |