Provider Demographics
NPI:1265884035
Name:MANGANIELLO, MARK EUGENE (RAH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EUGENE
Last Name:MANGANIELLO
Suffix:
Gender:M
Credentials:RAH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CAROL ANNS WAY
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-8701
Mailing Address - Country:US
Mailing Address - Phone:845-616-2313
Mailing Address - Fax:
Practice Address - Street 1:42 CAROL ANNS WAY
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-8701
Practice Address - Country:US
Practice Address - Phone:845-616-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist