Avita Pharmacy 1077

LBN: Avita Drugs, Llc
Avita Pharmacy 1077 is an health care organization with primary practice located at 2602 N Main Ave , San Antonio TX 78212-2919. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Avita Drugs, Llc can be contacted via phone (210) 736-3161, or through Colquitt, Carl Cody via phone (469) 592-2011.

Contact Information

Primary practice address
2602 N Main Ave San Antonio TX 78212-2919
Phone: (210) 736-3161
Fax: (210) 736-3175
Website:
Map and Directions
Authorized official contact:
Name: Colquitt, Carl Cody
Phone: (469) 592-2011

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 01935 Texas

Profile Details

NPI number 1295888949
LBN Legal business name Avita Drugs, Llc
DBA Doing business as Avita Pharmacy 1077
Authorized official Colquitt, Carl Cody
Entity Organization
Organization subpart 1 No
Enumeration date Jan 18th, 2007
Last updated Jan 31st, 2024 - about 8 months ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295888949 NPPES
Texas MEDICAID 130275

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