| NPI | 1396585261 |
|---|---|
| Doing Business As | AVITA PHARMACY 1083 |
| Entity Type | Organization |
| Authorized Contact | CARL CODY COLQUITT Chief Financial Officer 469-850-6930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-05-29 |