Provider Demographics
NPI:1457644262
Name:GRAEBNER, RICHARD DANIEL (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANIEL
Last Name:GRAEBNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MORENCI AVE
Mailing Address - Street 2:
Mailing Address - City:MIO
Mailing Address - State:MI
Mailing Address - Zip Code:48647-2508
Mailing Address - Country:US
Mailing Address - Phone:989-826-3737
Mailing Address - Fax:989-826-8967
Practice Address - Street 1:101 S MORENCI AVE
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-2508
Practice Address - Country:US
Practice Address - Phone:989-826-3737
Practice Address - Fax:989-826-8967
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist