Provider Demographics
NPI:1639507148
Name:VAUGHN, HALEY MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1403
Mailing Address - Country:US
Mailing Address - Phone:850-994-4861
Mailing Address - Fax:850-994-4871
Practice Address - Street 1:4739 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1403
Practice Address - Country:US
Practice Address - Phone:850-994-4861
Practice Address - Fax:850-994-4871
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist