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NPI Code Detail

MEDICARE: CHARLES JOSEPH VAUGHN III PHARMD

MEDICARE: CHARLES JOSEPH VAUGHN III 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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist48311TN

General Provider Information

NPI Number : 1659196178
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES JOSEPH VAUGHN III PHARMD
Provider Business Mailing Address
First Line : PO BOX 610
Second Line :
City : JAMESTOWN
State : TN
Zip : 38556-0610
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 346 W CENTRAL AVE
Second Line :
City : JAMESTOWN
State : TN
Zip : 38556-3407
Country : US
Telephone Number : 931-879-8133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2024
Last Update Date : 11/19/2024

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