Provider Demographics
NPI:1730598723
Name:GAFFNEY, DEREK (LADC, PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:GAFFNEY
Suffix:
Gender:M
Credentials:LADC, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 LABREE AVE N
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-1636
Mailing Address - Country:US
Mailing Address - Phone:218-681-8019
Mailing Address - Fax:
Practice Address - Street 1:915 LABREE AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-1636
Practice Address - Country:US
Practice Address - Phone:218-681-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121817183500000X
MN306610101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No183500000XPharmacy Service ProvidersPharmacist