Provider Demographics
NPI:1467061952
Name:GRAVES FAMILY PHARMACY
Entity Type:Organization
Organization Name:GRAVES FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:931-473-6418
Mailing Address - Street 1:357 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2519
Mailing Address - Country:US
Mailing Address - Phone:931-473-6418
Mailing Address - Fax:931-304-2828
Practice Address - Street 1:357 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2519
Practice Address - Country:US
Practice Address - Phone:931-473-6418
Practice Address - Fax:931-304-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ062108Medicaid