Healthcare Provider Details

I. General information

NPI: 1306818646
Provider Name (Legal Business Name): DENISE MARIE GRAHAM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHARMACY DEPARTMENT NAVAL HOSPITAL JACKSONVILLE 2080 CHILD STREET
JACKSONVILLE FL
32214-0001
US

IV. Provider business mailing address

1812 CHATHAM VILLAGE DR
ORANGE PARK FL
32003-8381
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-9651
  • Fax: 904-542-9649
Mailing address:
  • Phone: 904-269-2990
  • Fax: 904-542-9649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9994
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: