Provider Demographics
NPI:1003942616
Name:HAFNER, VAUGHN V (RPH)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:V
Last Name:HAFNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 GRANVIEW LN
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7787
Mailing Address - Country:US
Mailing Address - Phone:517-669-8094
Mailing Address - Fax:517-669-0905
Practice Address - Street 1:13157 SCHAVEY RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9016
Practice Address - Country:US
Practice Address - Phone:517-669-1287
Practice Address - Fax:517-668-0905
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037695183500000X
MO029664183500000X
KS09813183500000X
KY012784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist