Healthcare Provider Details

I. General information

NPI: 1972708022
Provider Name (Legal Business Name): MILDRED MANIAGO GABRIEL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILDRED GABRIEL ARCEO

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 SOUTH MARINE DRIVE GUAM REXALL DRUGS
TAMUNING GU
96913
US

IV. Provider business mailing address

PO BOX 9520
TAMUNING GU
96931
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-4827
  • Fax: 671-649-0051
Mailing address:
  • Phone: 671-649-2892
  • Fax: 671-647-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH013
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: