Organization
AVITA DRUGS FLORIDA, LLC
Active
Organization
AVITA DRUGS FLORIDA, LLC
Active
Other names
Avita Pharmacy 1066
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN BOYLE (REGULATORY COUNSEL)
(225) 236-1538
Entity
Organization
Contact information
Practice address
1409 NE 26TH ST, WILTON MANORS, FL 33305-1321
(954) 302-8170
(833) 884-0064
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
(225) 236-1541
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH33465
BOARD OF PHARMACY
FL
Enumeration date
06/22/2021
Last updated
03/08/2022
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