Healthcare Provider Details

I. General information

NPI: 1407842875
Provider Name (Legal Business Name): JEFF L VAUGHAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD MACDILL AFB
TAMPA FL
33621-1607
US

IV. Provider business mailing address

7437 MINT JULEP DR
RIVERVIEW FL
33569-8840
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9314
  • Fax:
Mailing address:
  • Phone: 813-484-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 39613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: