Provider Demographics
NPI:1003410341
Name:DUREN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DUREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 N HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-2751
Mailing Address - Country:US
Mailing Address - Phone:580-338-1312
Mailing Address - Fax:580-338-0542
Practice Address - Street 1:2602 N HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2751
Practice Address - Country:US
Practice Address - Phone:580-338-1312
Practice Address - Fax:580-338-0542
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist