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General NPI Number Information
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NPI Number | 1376134015
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Entity Type | Individual
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Provider Name | JOAN MANGARELLI RPH
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Gender | Female
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 575 GLYNN ST N
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1198
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Country | US
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Telephone | 770-461-3911
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Fax | 770-461-1121
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Provider Business Mailing Address
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Address Line | 215 SPEAR RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-5129
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Country | US
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Telephone | 973-495-1630
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Fax |
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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 | RPH011016
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License Number State | GA
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