Provider Demographics
NPI:1710256011
Name:GRIFFORD-VAUGHAN, MELYNDA PAGE (RPH)
Entity Type:Individual
Prefix:DR
First Name:MELYNDA
Middle Name:PAGE
Last Name:GRIFFORD-VAUGHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4601
Mailing Address - Country:US
Mailing Address - Phone:432-699-5991
Mailing Address - Fax:
Practice Address - Street 1:3300 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-4601
Practice Address - Country:US
Practice Address - Phone:432-699-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144235243OtherNPI