MEDICARE: RODERICK VAUGHT

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	183700000X	Pharmacy Technician	30158000	DC

General Provider Information

NPI Number	:	1588324404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERICK VAUGHT

Provider Business Mailing Address
First Line	:	3323 13TH ST SE APT 4
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4533
Country	:	US
Telephone Number	:	202-465-2845
Fax Number	:

Provider Business Practice Location Address
First Line	:	3323 13TH ST SE APT 4
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4533
Country	:	US
Telephone Number	:	202-465-2845
Fax Number	:

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

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	12/20/2021

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Directions to “ RODERICK VAUGHT ” Practice Location

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