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General NPI Number Information
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NPI Number | 1417694506
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Entity Type | Individual
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Provider Name | ZEBULON C GRAHAM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 545 SHOUP AVE STE 224
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3482
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Country | US
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Telephone | 208-528-3939
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Fax | 208-216-0230
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Provider Business Mailing Address
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Address Line | 545 SHOUP AVE STE 224
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3482
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Country | US
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Telephone | 208-528-3939
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Fax | 208-216-0230
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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 | P10481
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA-PHA-LIC-117474
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4543
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License Number State | WY
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