Provider Demographics
NPI:1760984397
Name:SOKOUDJOU TAKOUGANG, SIDONIE JOSIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIDONIE
Middle Name:JOSIANE
Last Name:SOKOUDJOU TAKOUGANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8323 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-1913
Mailing Address - Country:US
Mailing Address - Phone:443-248-8359
Mailing Address - Fax:
Practice Address - Street 1:3935 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2004
Practice Address - Country:US
Practice Address - Phone:410-342-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist