Provider Demographics
NPI:1609208248
Name:DURST, LAUREN LYNNETTE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LYNNETTE
Last Name:DURST
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 1:2219 BREWSTER DR
Mailing Address - Street 2:APARTMENT 337
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1786
Mailing Address - Country:US
Mailing Address - Phone:304-593-3324
Mailing Address - Fax:
Practice Address - Street 1:1601 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-2959
Practice Address - Country:US
Practice Address - Phone:843-488-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist