Basic Information
| Provider Information | |||||||||
| NPI: | 1093832909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAUGHN | ||||||||
| FirstName: | NIMITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24646 E FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800186052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038880815 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 568 US HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | BYERS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801039700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038229371 | ||||||||
| FaxNumber: | 3038229746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 15903 | CO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.