Provider Demographics
NPI:1659670800
Name:VAUGHAN, MARC A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:VAUGHAN
Suffix:
Gender:
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:N171W21840 CAYMUS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-1211
Mailing Address - Country:US
Mailing Address - Phone:262-677-1401
Mailing Address - Fax:
Practice Address - Street 1:N171W21840 CAYMUS CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-1211
Practice Address - Country:US
Practice Address - Phone:262-677-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293069183500000X
WI18274-401835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist