Provider Demographics
NPI:1073616439
Name:DURHAM, MARY BETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:MIRABITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 MARTHA ANN LANE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-767-1061
Mailing Address - Fax:
Practice Address - Street 1:2112 HELTON DRIVE
Practice Address - Street 2:MER-ROB PHARMACY
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-764-4474
Practice Address - Fax:256-764-3720
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist