Individual
ROGER PAUL MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
335 W APPLEWAY AVE, COEUR D ALENE, ID 83814-9306
(208) 765-1254
(208) 765-1303
Mailing address
335 W APPLEWAY AVE, COEUR D ALENE, ID 83814-9306
(208) 765-1254
(208) 765-1303
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P3920
ID
Other
Enumeration date
10/19/2011
Last updated
10/19/2011
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