Provider Demographics
NPI:1144693581
Name:NGASSA YONGUE, PATRICK JULIEN (RPH)
Entity type:Individual
Prefix:
First Name:PATRICK JULIEN
Middle Name:
Last Name:NGASSA YONGUE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TECHNOLOGY PARK STE 158
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6205
Mailing Address - Country:US
Mailing Address - Phone:407-268-7611
Mailing Address - Fax:
Practice Address - Street 1:100 TECHNOLOGY PARK STE 158
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6205
Practice Address - Country:US
Practice Address - Phone:407-268-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist