Provider Demographics
NPI:1861763922
Name:MANGANO, VICTORIA GOMEZ (RPH)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:GOMEZ
Last Name:MANGANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BROWNS WAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-9507
Mailing Address - Country:US
Mailing Address - Phone:804-897-0977
Mailing Address - Fax:804-897-1198
Practice Address - Street 1:626 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3261
Practice Address - Country:US
Practice Address - Phone:804-520-1571
Practice Address - Fax:804-520-6439
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4832540OtherNABP