Organization
AVITA DRUGS, LLC
Active
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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