Healthcare Provider Details

I. General information

NPI: 1487708236
Provider Name (Legal Business Name): LAURA MICHELLE DURHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 BACHMAN RD
SARDINIA OH
45171-9456
US

IV. Provider business mailing address

4126 HAGEMAN CROSSING RD
WILLIAMSBURG OH
45176-9549
US

V. Phone/Fax

Practice location:
  • Phone: 937-446-2545
  • Fax: 937-446-2600
Mailing address:
  • Phone: 513-724-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-22524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: