| NPI | 1417529363 |
|---|---|
| Doing Business As | AVITA PHARMACY 1068 |
| Entity Type | Organization |
| Authorized Contact | CHAD BROOKER Regulatory Counsel 469-592-2010 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |