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NPI Code Detail

MEDICARE: GWENDOLYN DURHAM

MEDICARE: GWENDOLYN DURHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist19424TX

General Provider Information

NPI Number : 1063749810
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN DURHAM
Provider Business Mailing Address
First Line : 5200 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77056-5413
Country : US
Telephone Number : 713-623-0643
Fax Number :
Provider Business Practice Location Address
First Line : 5200 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77056-5413
Country : US
Telephone Number : 713-623-0643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2009
Last Update Date : 11/14/2009

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Directions to “ GWENDOLYN DURHAM ” Practice Location

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