Organization
AVITA DRUGS OREGON, LLC
Active
Other names
Avita Pharmacy 1078
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ELLIS (CORPORATE COUNSEL)
(704) 641-7967
Entity
Organization
Contact information
Practice address
15 N MORRIS ST STE A, PORTLAND, OR 97227-1541
(469) 592-2011
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
12/12/2023
Last updated
12/12/2023
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