Provider Demographics
NPI:1508844481
Name:DURHAM, RICHARD L (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:DURHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 LINDENHURST DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3359
Mailing Address - Country:US
Mailing Address - Phone:937-435-6492
Mailing Address - Fax:
Practice Address - Street 1:6134 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-7029
Practice Address - Country:US
Practice Address - Phone:937-848-6691
Practice Address - Fax:937-848-3666
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist