Provider Demographics
NPI:1215947551
Name:VAUGHN, BRAD PATRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:PATRICK
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 NEW RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4501
Mailing Address - Country:US
Mailing Address - Phone:330-799-2503
Mailing Address - Fax:
Practice Address - Street 1:4350 NEW RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4501
Practice Address - Country:US
Practice Address - Phone:330-799-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-25199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist