MEDICARE: DR. RHEA VAUGHN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12917	OK

General Provider Information

NPI Number	:	1184064529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RHEA VAUGHN PHARMD

Provider Business Mailing Address
First Line	:	2622 E 123RD ST N
Second Line	:
City	:	SKIATOOK
State	:	OK
Zip	:	74070-3452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6336 E 4TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-1727
Country	:	US
Telephone Number	:	918-833-5180
Fax Number	:	918-835-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2013
Last Update Date	:	06/30/2013

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