Individual
FRANCES ANNA MAE BACONGUIS DYSINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
449 FOREST AVE, PORTLAND, ME 04101-2029
(207) 772-1928
Mailing address
449 FOREST AVE, PORTLAND, ME 04101-2029
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PR5158
ME
1835P2201X
Ambulatory Care Pharmacist
PR5158
ME
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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