Provider Demographics
NPI:1467142323
Name:AV 1 PHARMA LLC
Entity Type:Organization
Organization Name:AV 1 PHARMA LLC
Other - Org Name:PALATKA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-506-0060
Mailing Address - Street 1:PO BOX 600861
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0861
Mailing Address - Country:US
Mailing Address - Phone:904-506-0060
Mailing Address - Fax:904-515-5795
Practice Address - Street 1:164 S US HIGHWAY 17 STE 10
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-4066
Practice Address - Country:US
Practice Address - Phone:904-506-0060
Practice Address - Fax:904-515-5795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy