Provider Demographics
NPI:1184229163
Name:ASANGA, STANDLY NGWA (PHAMD)
Entity Type:Individual
Prefix:
First Name:STANDLY
Middle Name:NGWA
Last Name:ASANGA
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:NGWA
Other - Middle Name:ASANGA
Other - Last Name:STANDLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHAMD
Mailing Address - Street 1:6850 SHARLANDS AVE UNIT T1117
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2765
Mailing Address - Country:US
Mailing Address - Phone:617-291-8477
Mailing Address - Fax:
Practice Address - Street 1:1250 W 7TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4127
Practice Address - Country:US
Practice Address - Phone:775-747-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20366OtherNEVADA STATE BOARD OF PHARMACY