Provider Demographics
NPI:1710361050
Name:MANGUS, PAMELA (PHARM D)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MANGUS
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 1:575 TEMPLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2629
Mailing Address - Country:US
Mailing Address - Phone:949-497-2909
Mailing Address - Fax:
Practice Address - Street 1:2865 E COAST HWY STE 150
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2256
Practice Address - Country:US
Practice Address - Phone:949-644-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist