| NPI | 1740859024 |
|---|---|
| Doing Business As | AVITA PHARMACY 1066 |
| Entity Type | Organization |
| Authorized Contact | RYAN BOYLE Regulatory Counsel 225-236-1538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2022-03-08 |