Provider Demographics
NPI:1013690346
Name:MANGIAMELE, SEBASTIANO ROSARIO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIANO
Middle Name:ROSARIO
Last Name:MANGIAMELE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 MAPLE RIDGE CT NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8020
Mailing Address - Country:US
Mailing Address - Phone:218-766-5261
Mailing Address - Fax:
Practice Address - Street 1:107 W GREEN ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5282
Practice Address - Country:US
Practice Address - Phone:217-355-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist