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General NPI Number Information
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NPI Number | 1770991960
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Entity Type | Individual
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Provider Name | RODNEY GRAHAM
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Gender | Male
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 2730 GATEWAY ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477-9413
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Country | US
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Telephone | 541-521-0467
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Fax |
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Provider Business Mailing Address
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Address Line | 31074 LANES TURN RD
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City | EUGENE
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State | OR
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Zip | 97408-9413
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Country | US
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Telephone | 541-521-0467
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0007121
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License Number State | OR
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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 | 0007121
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License Number State | OR
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