Provider Demographics
NPI:1588933287
Name:GRAHAM, MELISSA (PHARMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 L ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1847
Mailing Address - Country:US
Mailing Address - Phone:402-738-8061
Mailing Address - Fax:
Practice Address - Street 1:2323 L ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1847
Practice Address - Country:US
Practice Address - Phone:402-738-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist