Provider Demographics
NPI:1639228760
Name:THOMPSON, VAUGHN KURTIS
Entity Type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:KURTIS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 24TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2580
Mailing Address - Country:US
Mailing Address - Phone:801-627-1175
Mailing Address - Fax:801-627-0770
Practice Address - Street 1:707 24TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2580
Practice Address - Country:US
Practice Address - Phone:801-627-1175
Practice Address - Fax:801-627-0770
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5115907-1714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5416290001Medicare NSC