Provider Demographics
NPI:1336734458
Name:VAUGHN, LARRY BRADFORD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BRADFORD
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 1:201 N ELMORE ST STE F
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-1260
Mailing Address - Country:US
Mailing Address - Phone:931-839-6777
Mailing Address - Fax:931-839-6779
Practice Address - Street 1:201 N ELMORE ST STE F
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:TN
Practice Address - Zip Code:38574-1260
Practice Address - Country:US
Practice Address - Phone:931-839-6777
Practice Address - Fax:931-839-6779
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist