Provider Demographics
NPI:1790384501
Name:VAUGHN, KRISTOPHER JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:JAMES
Last Name:VAUGHN
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 1:4513 BILES CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3703
Mailing Address - Country:US
Mailing Address - Phone:502-718-9018
Mailing Address - Fax:
Practice Address - Street 1:3616 BUECHEL BYP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2270
Practice Address - Country:US
Practice Address - Phone:502-458-9511
Practice Address - Fax:502-456-9285
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist