| NPI | 1831724244 |
|---|---|
| Doing Business As | AVITA PHARMACY 1004 |
| Entity Type | Organization |
| Authorized Contact | DALILA IBARRA Licensing & Credentialing Coordinat 657-286-7957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2024-03-14 |