Provider Demographics
NPI:1295595221
Name:YANDOUMA, REINE DEOGRACIA
Entity type:Individual
Prefix:
First Name:REINE
Middle Name:DEOGRACIA
Last Name:YANDOUMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9955 BUFFALO SPEEDWAY APT 9204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1336
Mailing Address - Country:US
Mailing Address - Phone:903-917-2734
Mailing Address - Fax:
Practice Address - Street 1:2990 MARINA BAY DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2732
Practice Address - Country:US
Practice Address - Phone:281-535-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist