Healthcare Provider Details

I. General information

NPI: 1346544160
Provider Name (Legal Business Name): SETH EDWARD GRAHAM D.O., PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2011
Last Update Date: 06/22/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 STAFFORD DR
PRINCETON WV
24740-2465
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE FL 5
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-2305
  • Fax:
Mailing address:
  • Phone: 304-388-4600
  • Fax: 304-388-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberED1222
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007262
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: