Provider Demographics
NPI:1558371252
Name:GAUGHAN, JOHN BRENTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRENTON
Last Name:GAUGHAN
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 1:725 W BAPTIST RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2454
Mailing Address - Country:US
Mailing Address - Phone:719-219-0230
Mailing Address - Fax:719-219-0236
Practice Address - Street 1:725 W BAPTIST RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2454
Practice Address - Country:US
Practice Address - Phone:719-219-0230
Practice Address - Fax:719-219-0236
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20658183500000X
ARPD09074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist