Provider Demographics
NPI:1801937149
Name:VAUGHAN, ANGIE (RPH)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CHAFFIN RD
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:AL
Mailing Address - Zip Code:35980
Mailing Address - Country:US
Mailing Address - Phone:205-466-3666
Mailing Address - Fax:205-466-5511
Practice Address - Street 1:PO BOX 611
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:AL
Practice Address - Zip Code:35952-0611
Practice Address - Country:US
Practice Address - Phone:205-466-3666
Practice Address - Fax:205-466-5511
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13213183500000X
ALAL 13213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003528Medicaid
AL009942445Medicaid