Provider Demographics
NPI:1437963873
Name:YASSA, ANGELA
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:YASSA
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 1:44677 SCHOENHERR RD APT 424
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1274
Mailing Address - Country:US
Mailing Address - Phone:248-376-3922
Mailing Address - Fax:
Practice Address - Street 1:2907 KRAFFT RD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-8628
Practice Address - Country:US
Practice Address - Phone:810-987-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024152221835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist