Provider Demographics
NPI:1609183698
Name:GRAEFF, MICHAEL P (RPH, FACA, CIP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:GRAEFF
Suffix:
Gender:M
Credentials:RPH, FACA, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 S COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-4051
Mailing Address - Country:US
Mailing Address - Phone:971-601-0551
Mailing Address - Fax:
Practice Address - Street 1:95 S COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-4051
Practice Address - Country:US
Practice Address - Phone:971-601-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00009612183500000X
ORRPH-0005837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist