Provider Demographics
NPI:1760770044
Name:VAUGHAN, CHRISTOPHER LEE (P D)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:P D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 EE WALLACE BLVD N
Mailing Address - Street 2:P. O. BOX 647
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2819
Mailing Address - Country:US
Mailing Address - Phone:318-757-4811
Mailing Address - Fax:318-757-4439
Practice Address - Street 1:109 EE WALLACE BLVD N
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2819
Practice Address - Country:US
Practice Address - Phone:318-757-4811
Practice Address - Fax:318-757-4439
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14608183500000X
MSE-7903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist