Provider Demographics
NPI:1700193372
Name:MANCUSO, ANGELA (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3396 HAMMOCKS DR APT 208
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-4208
Mailing Address - Country:US
Mailing Address - Phone:518-596-9347
Mailing Address - Fax:
Practice Address - Street 1:1405 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1113
Practice Address - Country:US
Practice Address - Phone:315-472-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist