MEDICARE: MR. ROBERT CHARLES MANGINO R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH011517	GA

General Provider Information

NPI Number	:	1598785255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT CHARLES MANGINO R.PH.

Provider Business Mailing Address
First Line	:	1055 TRAILMORE DR
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-2754
Country	:	US
Telephone Number	:	770-998-0230
Fax Number	:	770-594-7746

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FERRY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:	404-851-6270
Fax Number	:	404-303-3323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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