Provider Demographics
NPI:1528157641
Name:MANGANO, MICHAEL JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MANGANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 774
Mailing Address - Street 2:
Mailing Address - City:NORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23127-0774
Mailing Address - Country:US
Mailing Address - Phone:757-778-0631
Mailing Address - Fax:757-947-3745
Practice Address - Street 1:12720 MCMANUS BLVD
Practice Address - Street 2:GOOD HEALTH PHARMACY AT MARY IMMACULATE HOSPITAL
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-947-3743
Practice Address - Fax:757-947-3748
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist