Provider Demographics
NPI:1003052887
Name:GRAFF, KIM MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:MICHAEL
Last Name:GRAFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4289
Mailing Address - Country:US
Mailing Address - Phone:847-573-0061
Mailing Address - Fax:847-573-0081
Practice Address - Street 1:5560 CHURCHILL LN
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-4289
Practice Address - Country:US
Practice Address - Phone:847-573-0061
Practice Address - Fax:847-573-0081
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-030984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist