MEDICARE: MACARIO MAMANGUN

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	48710	CA

General Provider Information

NPI Number	:	1982086849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACARIO MAMANGUN

Provider Business Mailing Address
First Line	:	17400 DRAKE ST
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-1883
Country	:	US
Telephone Number	:	714-325-3456
Fax Number	:	714-792-0949

Provider Business Practice Location Address
First Line	:	1930 N PLACENTIA AVE
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92831-1522
Country	:	US
Telephone Number	:	714-792-0975
Fax Number	:	714-792-0949

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

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	06/26/2015

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Directions to “ MACARIO MAMANGUN ” Practice Location

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