Provider Demographics
NPI:1932646262
Name:DURHAM, DAVID LEE (RPH, DPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:DURHAM
Suffix:
Gender:M
Credentials:RPH, DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 QUEEN'S LANE
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513
Mailing Address - Country:US
Mailing Address - Phone:706-455-1846
Mailing Address - Fax:
Practice Address - Street 1:5679 APPALACHIAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513
Practice Address - Country:US
Practice Address - Phone:706-632-5026
Practice Address - Fax:706-632-3968
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022769183500000X
TN12002183500000X
FL55769183500000X
NC16320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist