Organization
AVITA DRUGS MISSISSIPPI, LLC
Active
Other names
Avita Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ELLIS (CORPORATE COUNSEL)
(803) 254-5884
Entity
Organization
Contact information
Practice address
805 E RIVER PL STE A, JACKSON, MS 39202-3486
(601) 336-1760
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
06/06/2019
Last updated
06/06/2019
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