Organization
AVITA DRUGS, LLC
Active
Other names
Avita Pharmacy 1085
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN GURLEY (GENERAL COUNSEL)
(469) 592-2011
Entity
Organization
Contact information
Practice address
3635 N HALSTED ST, CHICAGO, IL 60613-4315
(872) 710-6132
Mailing address
5700 GRANITE PKWY STE 425, PLANO, TX 75024-6648
(469) 592-2011
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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