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General NPI Number Information
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NPI Number | 1184227076
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Entity Type | Individual
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Provider Name | SUSAN E DURHAM PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 11/21/2020
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Last Update Date | 11/21/2020
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Provider Practice Location Address
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Address Line | 1520 SCENIC HWY N
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City | SNELLVILLE
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State | GA
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Zip | 30078-2130
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Country | US
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Telephone | 770-401-7430
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Fax |
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Provider Business Mailing Address
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Address Line | 985 HIGH SHOAL DR
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City | MONROE
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State | GA
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Zip | 30655-6318
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Country | US
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Telephone | 770-401-7430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH023256
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License Number State | GA
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