Organization
AVITA DRUGS LLC
Active
Other names
Avita Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN GURLEY (GENERAL COUNSEL)
(469) 592-2011
Entity
Organization
Contact information
Practice address
6100 CORPORATE BLVD STE 250, BATON ROUGE, LA 70808-2723
(225) 924-1930
(225) 924-2620
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
(225) 236-1540
(225) 663-2158
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234893
—
LA
01
—
2118871
PK
—
Enumeration date
05/08/2008
Last updated
10/17/2024
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