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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