Provider Demographics
NPI:1477836328
Name:GRAVES, SHERWYN NATHANIEL (RPH, MBA)
Entity Type:Individual
Prefix:
First Name:SHERWYN
Middle Name:NATHANIEL
Last Name:GRAVES
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7353 CLANCY WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9499
Mailing Address - Country:US
Mailing Address - Phone:614-378-5991
Mailing Address - Fax:
Practice Address - Street 1:6201 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5500
Practice Address - Country:US
Practice Address - Phone:614-367-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03119159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist