Provider Demographics
NPI:1689078099
Name:MUBANG, VICTOR
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:MUBANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04654-5215
Mailing Address - Country:US
Mailing Address - Phone:207-255-6400
Mailing Address - Fax:207-255-6410
Practice Address - Street 1:8 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654-5215
Practice Address - Country:US
Practice Address - Phone:207-255-6400
Practice Address - Fax:207-255-6410
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR125441835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist