Provider Demographics
NPI:1871651091
Name:VAUGHN, CANDICE L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:L
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 KERR BLVD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5231
Mailing Address - Country:US
Mailing Address - Phone:918-649-1100
Mailing Address - Fax:918-649-1102
Practice Address - Street 1:109 KERR BLVD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5231
Practice Address - Country:US
Practice Address - Phone:918-649-1100
Practice Address - Fax:918-649-1102
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK13112OtherSTATE LIC NUMBER