Provider Demographics
NPI:1588324404
Name:VAUGHT, RODERICK
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:VAUGHT
Suffix:
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 1:3323 13TH ST SE APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4533
Mailing Address - Country:US
Mailing Address - Phone:202-465-2845
Mailing Address - Fax:
Practice Address - Street 1:3323 13TH ST SE APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4533
Practice Address - Country:US
Practice Address - Phone:202-465-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC30158000183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician