Organization
AVITA DRUGS, LLC
Active
Other names
Avita Pharmacy 1083
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CHIEF FINANCIAL OFFICER)
(469) 850-6930
Entity
Organization
Contact information
Practice address
3406 BOB ROGERS DR STE 220, EAGLE PASS, TX 78852-5942
(830) 294-3264
Mailing address
5700 GRANITE PKWY STE 425, PLANO, TX 75024-6648
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
05/29/2024
Last updated
05/29/2024
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