Provider Demographics
NPI:1437632395
Name:GRAVES, LINDA G (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:PINECLIFFE
Mailing Address - State:CO
Mailing Address - Zip Code:80471-0483
Mailing Address - Country:US
Mailing Address - Phone:303-619-1743
Mailing Address - Fax:
Practice Address - Street 1:3497 HWY 72 #85
Practice Address - Street 2:
Practice Address - City:PINECLIFFE
Practice Address - State:CO
Practice Address - Zip Code:80471-8047
Practice Address - Country:US
Practice Address - Phone:303-619-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA0016239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA0016239OtherPHARMACIST LICENSE