Healthcare Provider Details

I. General information

NPI: 1053227272
Provider Name (Legal Business Name): RACHEL DURHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S SHOOP AVE
WAUSEON OH
43567-1702
US

IV. Provider business mailing address

725 S SHOOP AVE
WAUSEON OH
43567-1701
US

V. Phone/Fax

Practice location:
  • Phone: 419-330-2690
  • Fax: 419-330-2672
Mailing address:
  • Phone: 419-330-2690
  • Fax: 419-330-2672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03127520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: