Healthcare Provider Details

I. General information

NPI: 1023942091
Provider Name (Legal Business Name): GAVIN HEUSTIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 W SYCAMORE ST
KOKOMO IN
46901-4108
US

IV. Provider business mailing address

614 N MORRISON ST
KOKOMO IN
46901-3358
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-4437
  • Fax:
Mailing address:
  • Phone: 870-677-9398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45025061A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: