Provider Demographics
NPI:1598303034
Name:GRAVLEY, GRAHAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:
Last Name:GRAVLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 MARLOWE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2628
Mailing Address - Country:US
Mailing Address - Phone:216-409-2825
Mailing Address - Fax:
Practice Address - Street 1:8333 ROCKSIDE ROAD
Practice Address - Street 2:
Practice Address - City:VALLEY VIEW
Practice Address - State:OH
Practice Address - Zip Code:44125-4412
Practice Address - Country:US
Practice Address - Phone:877-355-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202207852OtherVA BOARD OF PHARMACY