| NPI | 1447904982 |
|---|---|
| Doing Business As | AVITA PHARMACY 1072 |
| Entity Type | Organization |
| Authorized Contact | CARL CODY COLQUITT CFO 469-592-2011 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2024-06-27 |