Provider Demographics
NPI:1881022002
Name:DURHAM, JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
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 1:261 E LESTER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1613
Mailing Address - Country:US
Mailing Address - Phone:559-269-5255
Mailing Address - Fax:
Practice Address - Street 1:261 E LESTER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1613
Practice Address - Country:US
Practice Address - Phone:559-269-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46186183500000X
TX29289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist