MEDICARE: MS. TERESA SHANKS GRAHAM R.PH., BCPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	0202001802	VA

General Provider Information

NPI Number	:	1164429098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA SHANKS GRAHAM R.PH., BCPP

Provider Business Mailing Address
First Line	:	101 SUMMERWOOD LN
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-1107
Country	:	US
Telephone Number	:	434-665-0483
Fax Number	:	434-947-2988

Provider Business Practice Location Address
First Line	:	521 COLONY RD
Second Line	:
City	:	MADISON HTS
State	:	VA
Zip	:	24572-2105
Country	:	US
Telephone Number	:	434-947-2081
Fax Number	:	434-947-2998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/30/2011

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