Provider Demographics
NPI:1114791522
Name:VAUGHN, CLINTON (RPH)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:VAUGHN
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 1:1210 MOHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3349
Mailing Address - Country:US
Mailing Address - Phone:541-747-3841
Mailing Address - Fax:541-747-3896
Practice Address - Street 1:1210 MOHAWK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3349
Practice Address - Country:US
Practice Address - Phone:541-747-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0019808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist