Provider Demographics
NPI:1386059590
Name:NGASSA, ALDA FANSI (PHARMD)
Entity type:Individual
Prefix:
First Name:ALDA
Middle Name:FANSI
Last Name:NGASSA
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 1:6622 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4010
Mailing Address - Country:US
Mailing Address - Phone:410-944-6611
Mailing Address - Fax:410-944-0236
Practice Address - Street 1:6622 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4010
Practice Address - Country:US
Practice Address - Phone:410-944-6611
Practice Address - Fax:410-944-0236
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist