Provider Demographics
NPI:1770865156
Name:MONGELLI, HAZEL SANGIL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:SANGIL
Last Name:MONGELLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3025
Mailing Address - Country:US
Mailing Address - Phone:201-796-0204
Mailing Address - Fax:
Practice Address - Street 1:100 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-3025
Practice Address - Country:US
Practice Address - Phone:201-796-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03100100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist