MEDICARE: RYAN CHRISTOPHER BANGO PHARMD

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	PCT.0010221	CT

General Provider Information

NPI Number	:	1851661359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN CHRISTOPHER BANGO PHARMD

Provider Business Mailing Address
First Line	:	4083 MAIN ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-2302
Country	:	US
Telephone Number	:	203-374-2819
Fax Number	:	203-374-5019

Provider Business Practice Location Address
First Line	:	4083 MAIN ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-2302
Country	:	US
Telephone Number	:	203-374-2819
Fax Number	:	203-374-5019

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

Provider Enumeration Date	:	12/31/2011
Last Update Date	:	12/31/2011

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