Provider Demographics
NPI:1003338187
Name:GRAVES, PHILIP EDWARD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EDWARD
Last Name:GRAVES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E FM 700 APT 418
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-5769
Mailing Address - Country:US
Mailing Address - Phone:210-569-2622
Mailing Address - Fax:
Practice Address - Street 1:2000 S GREGG ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5437
Practice Address - Country:US
Practice Address - Phone:432-263-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist