=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003942616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VAUGHN V HAFNER R.PH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13157 SCHAVEY RD
-----------------------------------------------------
City | DEWITT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48820-9016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-669-1287
-----------------------------------------------------
Fax | 517-668-0905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3098 GRANVIEW LN
-----------------------------------------------------
City | DEWITT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48820-7787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-669-8094
-----------------------------------------------------
Fax | 517-669-0905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302037695
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 029664
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 09813
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 012784
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------