Provider Demographics
NPI:1245666171
Name:DURHAM, HAYDEN LEE I (RPH)
Entity type:Individual
Prefix:MR
First Name:HAYDEN
Middle Name:LEE
Last Name:DURHAM
Suffix:I
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 1:1618 BLOSSOM TER
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2022
Mailing Address - Country:US
Mailing Address - Phone:352-633-5946
Mailing Address - Fax:
Practice Address - Street 1:10762 SOUTH US 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420
Practice Address - Country:US
Practice Address - Phone:352-347-4064
Practice Address - Fax:352-347-6832
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist