| NPI | 1154961837 |
|---|---|
| Doing Business As | AVITA PHARMACY 1014 |
| Entity Type | Organization |
| Authorized Contact | DALILA IBARRA Licensing & Credentialing COO Rdinat 657-286-7957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2024-03-14 |