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General NPI Number Information
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NPI Number | 1093004681
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Entity Type | Individual
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Provider Name | DEBORAH ANN GAVAGHAN RPH
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Gender | Female
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 9579 BRADDOCK RD
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City | FAIRFAX
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State | VA
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Zip | 22032-2539
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Country | US
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Telephone | 703-978-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 9579 BRADDOCK RD
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City | FAIRFAX
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State | VA
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Zip | 22032-2539
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Country | US
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Telephone | 703-978-0661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202007951
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10965
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12344
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS46230
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License Number State | FL
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