Active NPI
Jimmy Fredrick Vaughn III, PHARMD
- Pharmacist
- Greenville, TX
National Provider Identifier
1497461610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 70893
- Practice address
- 7401 I-30 Frontage Road
Greenville, TX 75402 - Phone
- (903) 454-6646
- NPI assigned
- Jan 31, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 70893 | TX | Primary |
Addresses
Primary practice location
7401 I-30 Frontage Road
Greenville, TX 75402
Mailing address
7401 I-30 Frontage Road
Greenville, TX 75402
Phone (903) 454-6646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70893 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675123200000",
"number": "1497461610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7401 I-30 FRONTAGE ROAD",
"city": "GREENVILLE",
"state": "TX",
"postal_code": "75402",
"telephone_number": "903-454-6646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7401 I-30 FRONTAGE ROAD",
"city": "GREENVILLE",
"state": "TX",
"postal_code": "75402",
"telephone_number": "903-454-6646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAUGHN",
"first_name": "JIMMY",
"middle_name": "FREDRICK",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-31",
"last_updated": "2023-01-31",
"certification_date": "2023-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "70893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.