Provider Demographics
NPI:1710117692
Name:GRAHAM, JAMES M (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2336
Mailing Address - Country:US
Mailing Address - Phone:610-280-7276
Mailing Address - Fax:610-280-7276
Practice Address - Street 1:201 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2336
Practice Address - Country:US
Practice Address - Phone:610-280-7276
Practice Address - Fax:610-280-7276
Is Sole Proprietor?:No
Enumeration Date:2009-07-25
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042674R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01713450Medicaid
PA3974626OtherNABP
PA064071282OtherMEDICARE DME