Provider Demographics
NPI:1619398286
Name:VAUGHAN, VALERIE SUMANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:SUMANN
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:SUMANN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:C/O OUTPATIENT PHARMACY
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-0860
Mailing Address - Country:US
Mailing Address - Phone:928-338-3502
Mailing Address - Fax:928-338-3510
Practice Address - Street 1:200 W HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941-0860
Practice Address - Country:US
Practice Address - Phone:928-338-3502
Practice Address - Fax:928-335-3510
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist