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General NPI Number Information
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NPI Number | 1457724429
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Entity Type | Individual
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Provider Name | SAMANTHA GRAHAM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 1980 RIO HILL CTR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1144
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Country | US
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Telephone | 434-978-1661
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Fax |
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Provider Business Mailing Address
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Address Line | 1389 STONE CREEK LN APT 206
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-7167
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Country | US
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Telephone | 516-993-9294
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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 | 0202214313
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License Number State | VA
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