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General NPI Number Information
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NPI Number | 1790408243
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Entity Type | Individual
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Provider Name | MARJORIE KAREN GRAHAM
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Gender | Female
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 2055 E VICTORY DR
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City | SAVANNAH
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State | GA
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Zip | 31404-3716
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Country | US
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Telephone | 912-352-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 505 COLUMBUS DR
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City | SAVANNAH
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State | GA
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Zip | 31405-4306
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Country | US
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Telephone | 912-429-3216
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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 | RPH014977
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License Number State | GA
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