Provider Demographics
NPI:1881128742
Name:DURAN, ERIC (RPH)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:DURAN
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 1:3353 E CAMINO ROJOS
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5417
Mailing Address - Country:US
Mailing Address - Phone:760-772-2969
Mailing Address - Fax:760-772-5070
Practice Address - Street 1:44075 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4871
Practice Address - Country:US
Practice Address - Phone:760-772-2969
Practice Address - Fax:760-772-5070
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist