Provider Demographics
NPI:1215184064
Name:GAVINO, FRANCIS MYRNA DOLAR (RPH)
Entity Type:Individual
Prefix:MRS
First Name:FRANCIS MYRNA
Middle Name:DOLAR
Last Name:GAVINO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:FRANCIS
Other - Middle Name:D
Other - Last Name:GAVINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1047 VIA SAN GALLO CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-0819
Mailing Address - Country:US
Mailing Address - Phone:702-431-8231
Mailing Address - Fax:
Practice Address - Street 1:5500 BOULDER HWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6010
Practice Address - Country:US
Practice Address - Phone:702-435-7339
Practice Address - Fax:702-352-1082
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist