Provider Demographics
NPI:1124641105
Name:NYANDJO, XAVIERA PASCALE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:XAVIERA
Middle Name:PASCALE
Last Name:NYANDJO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:XAVIERA PASCALE
Other - Middle Name:
Other - Last Name:DJOKO MEKOUGUEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1058 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-9112
Mailing Address - Country:US
Mailing Address - Phone:701-627-7621
Mailing Address - Fax:
Practice Address - Street 1:1058 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-9112
Practice Address - Country:US
Practice Address - Phone:701-627-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63783183500000X
NDRPH6202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist