Healthcare Provider Details

I. General information

NPI: 1124137260
Provider Name (Legal Business Name): DAVID THOMAS GAVIN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 WESTOWN PKWY
WEST DES MOINES IA
50266-8223
US

IV. Provider business mailing address

1003 W EUCLID AVE
INDIANOLA IA
50125-1235
US

V. Phone/Fax

Practice location:
  • Phone: 515-313-2706
  • Fax:
Mailing address:
  • Phone: 515-961-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14380
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: