Provider Demographics
NPI:1336450394
Name:COUNTS, GAVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:COUNTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 SUNCREST VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3596
Mailing Address - Country:US
Mailing Address - Phone:423-431-8808
Mailing Address - Fax:
Practice Address - Street 1:2790 E STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5849
Practice Address - Country:US
Practice Address - Phone:423-288-9286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist