MEDICARE: JACLYN S. GAVIN RPH, PHARMD, BCPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	2014021643	MO

General Provider Information

NPI Number	:	1699174441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN S. GAVIN RPH, PHARMD, BCPS

Provider Business Mailing Address
First Line	:	1310 24TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 S VIRGINIA ST
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-3507
Country	:	US
Telephone Number	:	270-885-2106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	10/02/2018

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