Provider Demographics
NPI:1629116611
Name:GACHUPIN, DEYVONNA ALLISON (CPHT)
Entity Type:Individual
Prefix:MS
First Name:DEYVONNA
Middle Name:ALLISON
Last Name:GACHUPIN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7161 HUSKY DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7729
Mailing Address - Country:US
Mailing Address - Phone:505-235-6084
Mailing Address - Fax:
Practice Address - Street 1:110 SHEEPSPRINGS RD
Practice Address - Street 2:
Practice Address - City:JEMEZ PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87024
Practice Address - Country:US
Practice Address - Phone:505-834-0130
Practice Address - Fax:505-834-3081
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT00001214183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician