Healthcare Provider Details

I. General information

NPI: 1801811211
Provider Name (Legal Business Name): H. SCOTT GRAHAM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W MAPLE AVE
LANCASTER KY
40444-1058
US

IV. Provider business mailing address

141 LONG BRANCH DR
LANCASTER KY
40444-9569
US

V. Phone/Fax

Practice location:
  • Phone: 859-792-4611
  • Fax: 859-792-3511
Mailing address:
  • Phone: 859-327-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10628
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: