Provider Demographics
NPI:1558547430
Name:GRAHAM, ELIZABETH WHITE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:WHITE
Last Name:GRAHAM
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 1:5300 WEST GENESEE STREET
Mailing Address - Street 2:PO BOX 128
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031
Mailing Address - Country:US
Mailing Address - Phone:315-487-0435
Mailing Address - Fax:315-487-0332
Practice Address - Street 1:5300 W GENESSE STREET
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-0128
Practice Address - Country:US
Practice Address - Phone:315-487-0435
Practice Address - Fax:315-487-0332
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist