| NPI | 1912746223 |
|---|---|
| Doing Business As | AVITA PHARMACY 1080 |
| Entity Type | Organization |
| Authorized Contact | RYAN BOYLE A VP, Legal Counsel 225-236-1538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2024-05-24 |