Individual
DR. CHARLES WESLEY DURHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, BCPS
Contact information
Practice address
3495 PIEDMONT RD NE BLDG 9, ATLANTA, GA 30305-1729
(703) 439-4986
Mailing address
3495 PIEDMONT RD NE BLDG 9, ATLANTA, GA 30305-1729
(703) 439-4986
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
LDO002227
GA
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
0202212968
VA
183700000X
Pharmacy Technician
PHI-015156
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202212968
STATE LICENSE
VA
01
—
LDO002227
STATE LICENSE
GA
01
—
PHI-015156
STATE LICENSE
GA
Enumeration date
11/21/2010
Last updated
10/19/2022
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