Provider Demographics
NPI:1346504156
Name:MENGUE NGOUA, REBECCA S (CERTIFIED PHARMACIST)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:MENGUE NGOUA
Suffix:
Gender:F
Credentials:CERTIFIED PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6498 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1444
Mailing Address - Country:US
Mailing Address - Phone:301-773-1074
Mailing Address - Fax:
Practice Address - Street 1:6498 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1444
Practice Address - Country:US
Practice Address - Phone:301-773-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MD28653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No374U00000XNursing Service Related ProvidersHome Health Aide