Provider Demographics
NPI:1467411322
Name:DURHAM, JAMES-MICHAEL WAYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMES-MICHAEL
Middle Name:WAYNE
Last Name:DURHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:W
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:KY
Mailing Address - Zip Code:42217-0206
Mailing Address - Country:US
Mailing Address - Phone:270-887-0166
Mailing Address - Fax:270-887-0201
Practice Address - Street 1:320 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1965
Practice Address - Country:US
Practice Address - Phone:270-887-0191
Practice Address - Fax:270-887-0201
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY011875OtherSTATE LICENSE