Provider Demographics
NPI:1376134015
Name:MANGARELLI, JOAN (RPH)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MANGARELLI
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 1:215 SPEAR RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5129
Mailing Address - Country:US
Mailing Address - Phone:973-495-1630
Mailing Address - Fax:
Practice Address - Street 1:575 GLYNN ST N
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1198
Practice Address - Country:US
Practice Address - Phone:770-461-3911
Practice Address - Fax:770-461-1121
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist