Provider Demographics
NPI:1376186916
Name:MBENG, MARION BESSEM (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:BESSEM
Last Name:MBENG
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 1:6406 FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3346
Mailing Address - Country:US
Mailing Address - Phone:240-704-3093
Mailing Address - Fax:
Practice Address - Street 1:8601 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1500
Practice Address - Country:US
Practice Address - Phone:301-322-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist