Provider Demographics
NPI:1467823088
Name:HUSSON UNIVERSITY
Entity Type:Organization
Organization Name:HUSSON UNIVERSITY
Other - Org Name:HUSSON SCHOOL OF PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY STUDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEDOR
Authorized Official - Middle Name:FRIDAY
Authorized Official - Last Name:TEEKATE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:515-639-1677
Mailing Address - Street 1:1 CIRCLE COLLEGE # DLC 313A
Mailing Address - Street 2:HUSSON UNIVERSITY
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:515-639-1677
Mailing Address - Fax:
Practice Address - Street 1:7056 CONROE MILL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253
Practice Address - Country:US
Practice Address - Phone:515-639-1677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========OtherSTUDENT