Healthcare Provider Details

I. General information

NPI: 1073616439
Provider Name (Legal Business Name): MARY BETH DURHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MARY BETH MIRABITO

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HELTON DRIVE MER-ROB PHARMACY
FLORENCE AL
35630
US

IV. Provider business mailing address

110 MARTHA ANN LANE
FLORENCE AL
35630
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-4474
  • Fax: 256-764-3720
Mailing address:
  • Phone: 256-767-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11432
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: