Provider Demographics
NPI:1184227076
Name:DURHAM, SUSAN E (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:DURHAM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 HIGH SHOAL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-6318
Mailing Address - Country:US
Mailing Address - Phone:770-401-7430
Mailing Address - Fax:
Practice Address - Street 1:1520 SCENIC HWY N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2130
Practice Address - Country:US
Practice Address - Phone:770-401-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist