Provider Demographics
NPI:1114423654
Name:GRAVES, LORI JEAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEAN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4745
Mailing Address - Country:US
Mailing Address - Phone:701-252-3002
Mailing Address - Fax:701-252-3149
Practice Address - Street 1:703 1ST AVE S
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4745
Practice Address - Country:US
Practice Address - Phone:701-252-3002
Practice Address - Fax:701-252-3149
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH4325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist