Provider Demographics
NPI:1730717620
Name:GAVIN, LEAH A (RPH)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:GAVIN
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2505
Mailing Address - Country:US
Mailing Address - Phone:715-425-2255
Mailing Address - Fax:715-425-2889
Practice Address - Street 1:104 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2423
Practice Address - Country:US
Practice Address - Phone:715-425-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8887-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIR8887OtherLICENSE