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General NPI Number Information
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NPI Number | 1174645899
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Entity Type | Individual
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Provider Name | MADELINE MANGUAL LIC 002465
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CALLE AUTONOMIA #71 FARMACIA SAN ANTONIO
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | US
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Telephone | 787-876-2705
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Fax | 787-876-0558
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Provider Business Mailing Address
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Address Line | CALLE ORQUIDEA #300 CIVDAD APERDIN
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-276-6162
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Fax | 787-876-0558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 002465
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License Number State | PR
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