Provider Demographics
NPI:1396944369
Name:MANGHAM, JAMIE MAPES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MAPES
Last Name:MANGHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MAPES
Other - Last Name:ANNEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3726 MYKONOS LN
Mailing Address - Street 2:#143
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5551
Mailing Address - Country:US
Mailing Address - Phone:208-420-2667
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program