| NPI | 1851462873 |
|---|---|
| Doing Business As | AVITA PHARMACY 1076 |
| Entity Type | Organization |
| Authorized Contact | CARL CODY COLQUITT Chief Financial Officer 469-592-2011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: TX 02258) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2023-04-17 |