Provider Demographics
NPI:1750859971
Name:GAUGHAN, JOSEPH JOHN III
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:GAUGHAN
Suffix:III
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 1:617 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2849
Mailing Address - Country:US
Mailing Address - Phone:570-209-7440
Mailing Address - Fax:
Practice Address - Street 1:617 3RD ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2849
Practice Address - Country:US
Practice Address - Phone:570-209-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4506651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP450665OtherPHARMACY LICENSE