Healthcare Provider Details

I. General information

NPI: 1861305963
Provider Name (Legal Business Name): JAY TIMOTHY GRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 HIGHWAY 805
JENKINS KY
41537-8182
US

IV. Provider business mailing address

PO BOX 788
POUND VA
24279-0788
US

V. Phone/Fax

Practice location:
  • Phone: 606-832-2084
  • Fax: 606-832-2096
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number015270
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: