Provider Demographics
NPI:1518261338
Name:GRABER, JOELY MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JOELY
Middle Name:MARIE
Last Name:GRABER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-9705
Mailing Address - Country:US
Mailing Address - Phone:518-237-3834
Mailing Address - Fax:
Practice Address - Street 1:217 REMSEN ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-3024
Practice Address - Country:US
Practice Address - Phone:518-237-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY41398183500000X
VT033.0003183183500000X
MA21881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist