Provider Demographics
NPI:1104191675
Name:GRAF, GERALD (RPH)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:GRAF
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 1:1212 SPAR CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-2500
Mailing Address - Country:US
Mailing Address - Phone:760-918-9303
Mailing Address - Fax:760-918-9304
Practice Address - Street 1:1212 SPAR CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-2500
Practice Address - Country:US
Practice Address - Phone:760-918-9303
Practice Address - Fax:760-918-9304
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist