Active NPI
Mark R Gavin, RPH
- Pharmacotherapy Pharmacist
- Wilkes-Barre, PA
National Provider Identifier
1407091861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- RP043229L
- Practice address
- 1000 East Mountain Drive
Wilkes-Barre, PA 18711 - Phone
- (570) 826-7707
- NPI assigned
- Dec 12, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | RP043229L | PA | Primary |
Addresses
Primary practice location
1000 East Mountain Drive
Wilkes-Barre, PA 18711
Mailing address
1000 East Mountain Drive
Wilkes-Barre, PA 18711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP043229L | PA | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229040000000",
"number": "1407091861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 EAST MOUNTAIN DRIVE",
"city": "WILKES-BARRE",
"state": "PA",
"postal_code": "18711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 EAST MOUNTAIN DRIVE",
"city": "WILKES-BARRE",
"state": "PA",
"postal_code": "18711",
"telephone_number": "570-826-7707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "MARK",
"middle_name": "R",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-12",
"last_updated": "2008-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "PA",
"license": "RP043229L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes-Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.