Individual
JENNA VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
23620 N 20TH DR, SUITE 12, PHOENIX, AZ 85085-0621
(877) 546-5779
(877) 546-5780
Mailing address
110 E GREENWAY PKWY, APT 2007, PHOENIX, AZ 85022-2527
(719) 964-5641
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S022155
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S022155
ARIZONA PHARMACIST LICENSE
AZ
Enumeration date
09/12/2016
Last updated
09/12/2016
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