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General NPI Number Information
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NPI Number | 1275856833
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Entity Type | Individual
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Provider Name | JENNIFER L VAUGHN RPH
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Gender | Female
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 211 MAIN ST
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City | MOUND CITY
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State | IL
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Zip | 62963-1163
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Country | US
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Telephone | 618-748-9253
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Fax | 618-748-9850
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Provider Business Mailing Address
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Address Line | PO BOX 110
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City | MOUND CITY
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State | IL
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Zip | 62963-0110
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Country | US
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Telephone | 618-748-9253
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Fax | 618-748-9850
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051-286696
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License Number State | IL
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