Provider Demographics
NPI:1528369840
Name:VAUGHN, MARIA CONSUELO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA CONSUELO
Middle Name:
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 1:17202 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5130
Mailing Address - Country:US
Mailing Address - Phone:206-364-4618
Mailing Address - Fax:206-367-9262
Practice Address - Street 1:17202 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5130
Practice Address - Country:US
Practice Address - Phone:206-364-4618
Practice Address - Fax:206-367-9262
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00018582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist