Provider Demographics
NPI:1164429098
Name:GRAHAM, TERESA SHANKS (RPH, BCPP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:SHANKS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RPH, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SUMMERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1107
Mailing Address - Country:US
Mailing Address - Phone:434-665-0483
Mailing Address - Fax:434-947-2988
Practice Address - Street 1:521 COLONY RD
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2105
Practice Address - Country:US
Practice Address - Phone:434-947-2081
Practice Address - Fax:434-947-2998
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020018021835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric