Provider Demographics
NPI:1629051453
Name:VOGAN, JEFFREY LAWRENCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:VOGAN
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 1:13616 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087
Mailing Address - Country:US
Mailing Address - Phone:425-742-1120
Mailing Address - Fax:425-742-9183
Practice Address - Street 1:13616 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE C
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087
Practice Address - Country:US
Practice Address - Phone:425-742-1120
Practice Address - Fax:425-742-9183
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011051183500000X
CARPH 35915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist