Organization
AVITA DRUGS, LLC
Active
Other names
Avita Pharmacy 1076
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CHIEF FINANCIAL OFFICER)
(469) 592-2011
Entity
Organization
Contact information
Practice address
6406 MCPHERSON RD STE 6, LAREDO, TX 78041-6258
(866) 270-3226
(888) 959-5908
Mailing address
5700 GRANITE PARKWAY, SUITE 425, PLANO, TX 75024-6648
(469) 592-2011
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
02258
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146631
—
TX
01
—
4504608
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/13/2006
Last updated
12/16/2024
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