Provider Demographics
NPI:1346544160
Name:GRAHAM, SETH EDWARD (DO, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:EDWARD
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DO, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE SE FL 5
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-4600
Mailing Address - Fax:304-388-4603
Practice Address - Street 1:1213 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2465
Practice Address - Country:US
Practice Address - Phone:304-487-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVED1222207QA0505X
WVRP0007262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No183500000XPharmacy Service ProvidersPharmacist