Provider Demographics
NPI:1386905289
Name:CIRANGLE, MARYELLEN (RPH)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:CIRANGLE
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 1:25 KINNELON RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2337
Mailing Address - Country:US
Mailing Address - Phone:973-838-6699
Mailing Address - Fax:973-838-1236
Practice Address - Street 1:25 KINNELON RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2337
Practice Address - Country:US
Practice Address - Phone:973-838-6699
Practice Address - Fax:973-838-1236
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01974900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist