Provider Demographics
NPI:1851427108
Name:MANGUAL, MARISEL
Entity Type:Individual
Prefix:
First Name:MARISEL
Middle Name:
Last Name:MANGUAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PEREYO ORION ST
Mailing Address - Street 2:#2
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-607-1437
Mailing Address - Fax:797-285-4095
Practice Address - Street 1:FARMACIA MARISEL FONT MARTELO ST
Practice Address - Street 2:#104
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-9246
Practice Address - Fax:787-850-5600
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4201183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician