Healthcare Provider Details

I. General information

NPI: 1356432843
Provider Name (Legal Business Name): LARISSA RETTA GRAFF PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE BOX 0622, ROOM C-152
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

521 PARNASSUS AVE BOX 0622, ROOM C-152
SAN FRANCISCO CA
94143-2206
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1850
  • Fax: 415-353-1217
Mailing address:
  • Phone: 415-353-1850
  • Fax: 415-353-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 49889
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 14181
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: