Healthcare Provider Details

I. General information

NPI: 1376472423
Provider Name (Legal Business Name): JANET VAUGHN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

3860 E FORKED DEER LN
BOISE ID
83716-5870
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2490
  • Fax:
Mailing address:
  • Phone: 208-914-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberP4644
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: