Provider Demographics
NPI:1689861072
Name:DURHAM, MELISSA JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JEAN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 ZONAL AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-442-1481
Mailing Address - Fax:323-442-1823
Practice Address - Street 1:1985 ZONAL AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-442-1481
Practice Address - Fax:323-442-1823
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist