Provider Demographics
NPI:1336584200
Name:VAUGHAN, CHARLES PRICE IV
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PRICE
Last Name:VAUGHAN
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-0224
Mailing Address - Country:US
Mailing Address - Phone:256-740-2434
Mailing Address - Fax:
Practice Address - Street 1:2701 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1402
Practice Address - Country:US
Practice Address - Phone:256-740-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist