Individual
DANIELLE MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-7374
Mailing address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
051298004
IL
Other
Enumeration date
04/12/2018
Last updated
03/10/2022
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