MEDICARE: PAMELA MANGUS PHARM D.

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	46381	CA

General Provider Information

NPI Number	:	1710361050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MANGUS PHARM D.

Provider Business Mailing Address
First Line	:	575 TEMPLE HILLS DR
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2629
Country	:	US
Telephone Number	:	949-497-2909
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865 E COAST HWY STE 150
Second Line	:
City	:	CORONA DEL MAR
State	:	CA
Zip	:	92625-2256
Country	:	US
Telephone Number	:	949-644-7575
Fax Number	:

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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Directions to “ PAMELA MANGUS PHARM D.” Practice Location

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