Healthcare Provider Details

I. General information

NPI: 1770525206
Provider Name (Legal Business Name): GRAHAM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 E WASHINGTON ST
ARMA KS
66712-4098
US

IV. Provider business mailing address

PO BOX 809
ARMA KS
66712-0809
US

V. Phone/Fax

Practice location:
  • Phone: 620-347-8311
  • Fax: 620-347-8915
Mailing address:
  • Phone: 620-347-8311
  • Fax: 620-347-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number210016
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURIE GRAHAM
Title or Position: PRESIDENT AND PIC
Credential: PHARM.D.
Phone: 620-347-8311