Provider Demographics
NPI:1164026886
Name:GAVIN, VICTORIA R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:R
Last Name:GAVIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6596 S STATE ROAD 161
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-8955
Mailing Address - Country:US
Mailing Address - Phone:618-798-0609
Mailing Address - Fax:
Practice Address - Street 1:610 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-1044
Practice Address - Country:US
Practice Address - Phone:812-683-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026736A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist