Provider Demographics
NPI:1720268071
Name:MANGANO, BRANDI LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEIGH
Last Name:MANGANO
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 1:13245 OTTENBECKER RD
Mailing Address - Street 2:
Mailing Address - City:LAWTONS
Mailing Address - State:NY
Mailing Address - Zip Code:14091-9791
Mailing Address - Country:US
Mailing Address - Phone:716-532-9066
Mailing Address - Fax:
Practice Address - Street 1:81 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1318
Practice Address - Country:US
Practice Address - Phone:716-532-4114
Practice Address - Fax:716-532-5825
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist