Organization
AVITA DRUGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CFO)
(469) 850-6930
Entity
Organization
Contact information
Practice address
722 ISOM RD STE 103, SAN ANTONIO, TX 78216-4026
(726) 223-4500
Mailing address
10604 COURSEY BLVD, BATON ROUGE, LA 70816-4015
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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