Provider Demographics
NPI:1659670800
Name:VAUGHAN, MARC A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W NORTH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-8202
Mailing Address - Country:US
Mailing Address - Phone:815-478-4477
Mailing Address - Fax:815-478-5530
Practice Address - Street 1:540 W NORTH ST STE 211
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-8202
Practice Address - Country:US
Practice Address - Phone:815-478-4477
Practice Address - Fax:815-478-5530
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist