Provider Demographics
NPI:1497047112
Name:MANGO, LAWRENCE JOHN SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:MANGO
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:141 HANNAFORD SQ
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1653
Mailing Address - Country:US
Mailing Address - Phone:802-442-3642
Mailing Address - Fax:802-442-3065
Practice Address - Street 1:141 HANNAFORD SQ
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1653
Practice Address - Country:US
Practice Address - Phone:802-442-3642
Practice Address - Fax:802-442-3065
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI036415183500000X
VT033-0002889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist