Provider Demographics
NPI:1093990921
Name:DE GRAFFENRIED, CHRISTOPHER LAWRENCE JR (PHARM D, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LAWRENCE
Last Name:DE GRAFFENRIED
Suffix:JR
Gender:M
Credentials:PHARM D, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VANDENBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6039
Mailing Address - Country:US
Mailing Address - Phone:518-272-1355
Mailing Address - Fax:
Practice Address - Street 1:75 VANDENBURGH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6039
Practice Address - Country:US
Practice Address - Phone:518-272-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02906458Medicaid