Healthcare Provider Details

I. General information

NPI: 1194819409
Provider Name (Legal Business Name): NEW GRAHAM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 VIRGINIA AVE
BLUEFIELD VA
24605-1729
US

IV. Provider business mailing address

566 VIRGINIA AVENUE
BLUEFIELD VA
24605
US

V. Phone/Fax

Practice location:
  • Phone: 276-326-1166
  • Fax: 276-326-3784
Mailing address:
  • Phone: 276-326-1166
  • Fax: 276-326-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201001822
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY NIPPER
Title or Position: PIC
Credential: RPH
Phone: 276-326-1166