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General NPI Number Information
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NPI Number | 1164902995
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Entity Type | Individual
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Provider Name | MCKENZIE ANN GRAHAM PHARMD, RPH
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Gender | Female
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 845 N FEDERAL BLVD
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City | RIVERTON
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State | WY
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Zip | 82501
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Country | US
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Telephone | 307-857-6023
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Fax |
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Provider Business Mailing Address
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Address Line | 418 W PERSHING AVE APT 4
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City | RIVERTON
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State | WY
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Zip | 82501-2428
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Country | US
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Telephone | 307-331-8892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4056
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License Number State | WY
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