Provider Demographics
NPI:1467738971
Name:DURHAM, CHRISTINE DIANE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DIANE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4116
Mailing Address - Country:US
Mailing Address - Phone:334-332-2074
Mailing Address - Fax:
Practice Address - Street 1:14065 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1964
Practice Address - Country:US
Practice Address - Phone:912-925-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025159183500000X
SCPH12678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist