Provider Demographics
NPI:1295258499
Name:BESONG, PAUL EYONG (STUDENT PHARMACIST)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EYONG
Last Name:BESONG
Suffix:
Gender:M
Credentials:STUDENT PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ACADIA PL
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2303
Mailing Address - Country:US
Mailing Address - Phone:207-404-3410
Mailing Address - Fax:
Practice Address - Street 1:750 UNOIN STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-942-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program