Provider Demographics
NPI:1174806145
Name:DURHAM, LESLIE JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JEAN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 CLOVER PINE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47124-9536
Mailing Address - Country:US
Mailing Address - Phone:812-207-6599
Mailing Address - Fax:
Practice Address - Street 1:4920 CLOVER PINE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IN
Practice Address - Zip Code:47124-9536
Practice Address - Country:US
Practice Address - Phone:812-207-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018704A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist