Provider Demographics
NPI:1295826279
Name:VAUGHN, GAIL M (RPH)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14459 LAWRENCE 2090
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-6210
Mailing Address - Country:US
Mailing Address - Phone:417-466-7246
Mailing Address - Fax:
Practice Address - Street 1:606 E MOUNT VERNON BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-9100
Practice Address - Country:US
Practice Address - Phone:417-466-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO043349OtherPHARMACIST LICENSE