Organization
AVITA DRUGS LLC
Active
Other names
Avita Drugs LLC d/b/a Avita Pharmacy 1071
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CFO)
(469) 850-6930
Entity
Organization
Contact information
Practice address
600 PENNSYLVANIA AVE SE, WASHINGTON, DC 20003-4316
(202) 978-1565
Mailing address
5700 GRANITE PKWY STE 425, PLANO, TX 75024-6648
(469) 915-4843
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
06/27/2023
Last updated
06/27/2023
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