Provider Demographics
NPI:1750566428
Name:MANGUSAN, RICHARD G (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:MANGUSAN
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:G
Other - Last Name:MANGUSAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPHT
Mailing Address - Street 1:6447 CRABTREE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7040
Mailing Address - Country:US
Mailing Address - Phone:619-475-2256
Mailing Address - Fax:
Practice Address - Street 1:6447 CRABTREE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7040
Practice Address - Country:US
Practice Address - Phone:619-475-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH50665183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician