Organization
AVITA DRUGS, LLC
Active
Organization
AVITA DRUGS, LLC
Active
Other names
Avita Pharmacy 1077
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CHIEF FINANCIAL OFFICER)
(469) 592-2011
Entity
Organization
Contact information
Practice address
2602 N MAIN AVE, SAN ANTONIO, TX 78212-2919
(210) 736-3161
(210) 736-3175
Mailing address
5700 GRANITE PARKWAY, SUITE 425, PLANO, TX 75024-6648
(469) 592-2011
(210) 736-3175
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
01935
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130275
—
TX
Enumeration date
01/18/2007
Last updated
01/31/2024
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