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General NPI Number Information
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NPI Number | 1497047112
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Entity Type | Individual
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Provider Name | LAWRENCE JOHN MANGO SR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 141 HANNAFORD SQ
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City | BENNINGTON
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State | VT
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Zip | 05201-1653
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Country | US
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Telephone | 802-442-3642
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Fax | 802-442-3065
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Provider Business Mailing Address
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Address Line | 141 HANNAFORD SQ
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City | BENNINGTON
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State | VT
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Zip | 05201-1653
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Country | US
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Telephone | 802-442-3642
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Fax | 802-442-3065
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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 | I036415
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 033-0002889
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License Number State | VT
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