Provider Demographics
NPI:1184229163
Name:ASANGA, STANDLY NGWA (PHAMD)
Entity type:Individual
Prefix:
First Name:STANDLY
Middle Name:NGWA
Last Name:ASANGA
Suffix:
Gender:
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 1:1409 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6062
Mailing Address - Country:US
Mailing Address - Phone:617-291-8477
Mailing Address - Fax:
Practice Address - Street 1:1200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-5320
Practice Address - Country:US
Practice Address - Phone:903-887-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX68300OtherTEXAS STATE BOARD OF PHARMACY