| NPI | 1104326172 |
|---|---|
| Doing Business As | AVITA PHARMACY 1073 |
| Entity Type | Organization |
| Authorized Contact | CARL CODY COLQUITT Chief Financial Officer 469-850-6930 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2022-07-06 |