Organization
AVITA DRUGS LLC
Active
Other names
AVITA DRUGS LLC
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE MOUBRY (VP OF FINANCE)
(504) 737-4007
Entity
Organization
Contact information
Practice address
6226 JEFFERSON HWY, STE G, HARAHAN, LA 70123-5153
(504) 737-4007
(504) 737-4008
Mailing address
6226 JEFFERSON HWY, STE G, HARAHAN, LA 70123-5153
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
6048IR
LA
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04874393
—
MS
05
—
1271152
—
LA
01
—
1931345
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/23/2007
Last updated
02/12/2009
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