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General NPI Number Information
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NPI Number | 1184229163
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Entity Type | Individual
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Provider Name | STANDLY NGWA ASANGA PHAM.D
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1200 W MAIN ST
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-5320
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Country | US
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Telephone | 903-887-2133
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 RAVENWOOD DR
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City | MANSFIELD
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State | TX
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Zip | 76063-6062
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Country | US
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Telephone | 617-291-8477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 68300
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License Number State | TX
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