Provider Demographics
NPI:1407088586
Name:GRAVES, REBECCA ANN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7775
Mailing Address - Country:US
Mailing Address - Phone:760-208-6000
Mailing Address - Fax:760-666-6297
Practice Address - Street 1:1751 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7775
Practice Address - Country:US
Practice Address - Phone:760-208-6000
Practice Address - Fax:760-666-6297
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005030404183500000X
NY052329-1183500000X
CA66658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist