Provider Demographics
NPI:1962926170
Name:MANGANO, JARED LUCAS (RPH)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:LUCAS
Last Name:MANGANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COMPUTER DR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-1236
Mailing Address - Country:US
Mailing Address - Phone:978-377-9004
Mailing Address - Fax:978-377-1183
Practice Address - Street 1:35 COMPUTER DR
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-1236
Practice Address - Country:US
Practice Address - Phone:978-377-9004
Practice Address - Fax:978-377-1183
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0021830183500000X
MAPH239499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH239499OtherSTATE PHARMACIST LICENSE
COPHA.0021830OtherSTATE PHARMACIST LICENSE
NHPHCY-01051OtherSTATE PHARMACIST LICENSE