Provider Demographics
NPI:1700190402
Name:MANGU, ANAND (RPH)
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:MANGU
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 1:4718 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1928
Mailing Address - Country:US
Mailing Address - Phone:302-995-2286
Mailing Address - Fax:302-995-2862
Practice Address - Street 1:4718 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1928
Practice Address - Country:US
Practice Address - Phone:302-995-2286
Practice Address - Fax:302-995-2862
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA1-0003836OtherSTATE LICENSE