Provider Demographics
NPI:1508230699
Name:VAUGHN, ROBERT II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:VAUGHN
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-454-0194
Mailing Address - Fax:803-451-7129
Practice Address - Street 1:1626 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2818
Practice Address - Country:US
Practice Address - Phone:803-454-0194
Practice Address - Fax:803-451-7129
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist