Provider Demographics
NPI:1962816223
Name:AVITA DRUGS LLC
Entity Type:Organization
Organization Name:AVITA DRUGS LLC
Other - Org Name:AVITA SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF IT & VENDOR MGMT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-254-5884
Mailing Address - Street 1:5551 CORPORATE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2567
Mailing Address - Country:US
Mailing Address - Phone:225-924-1930
Mailing Address - Fax:225-924-2620
Practice Address - Street 1:5551 CORPORATE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2512
Practice Address - Country:US
Practice Address - Phone:225-924-1930
Practice Address - Fax:225-924-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006081-IR3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146281OtherPK