Healthcare Provider Details

I. General information

NPI: 1922026962
Provider Name (Legal Business Name): GRAHAM SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 2ND ST
BALDWYN MS
38824-2216
US

IV. Provider business mailing address

111 SOUTH SECOND AVE. P.O. DRAWER B
BALDWYN MS
38824-0047
US

V. Phone/Fax

Practice location:
  • Phone: 662-365-5294
  • Fax: 662-365-5295
Mailing address:
  • Phone: 662-365-5294
  • Fax: 662-365-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-5900
License Number StateMS

VIII. Authorized Official

Name: MR. THOMAS G GRAHAM II
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 662-365-5294