Provider Demographics
NPI:1598864373
Name:MANGOLD, RAYMOND PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PAUL
Last Name:MANGOLD
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 1:8402 CLARENCE LANE CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051
Mailing Address - Country:US
Mailing Address - Phone:716-741-1138
Mailing Address - Fax:716-893-1325
Practice Address - Street 1:1408 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211
Practice Address - Country:US
Practice Address - Phone:716-893-1226
Practice Address - Fax:716-893-1325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist