MEDICARE: DR. RONALD D. GRAHAM D.PH.

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	183500000X	Pharmacist	8312	OK
2	183500000X	Pharmacist	19756	TX

General Provider Information

NPI Number	:	1740282334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD D. GRAHAM D.PH.

Provider Business Mailing Address
First Line	:	2713 SW 110TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2441
Country	:	US
Telephone Number	:	405-691-0608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 NE 13TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-9039
Fax Number	:	405-271-2615

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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