Organization
AVITA DRUGS TENNESSEE, LLC
Active
Other names
Avita Pharmacy 1065
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN BOYLE (REGULATORY COUNSEL)
(225) 236-1538
Entity
Organization
Contact information
Practice address
1005 DR. B. TODD JR. BLVD, SUITE 332, NASHVILLE, TN 37208
(321) 369-9495
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
(225) 236-1541
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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