Provider Demographics
NPI:1821242140
Name:GRAHAM, LAURIE (RPH)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
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:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-0988
Mailing Address - Country:US
Mailing Address - Phone:252-261-7999
Mailing Address - Fax:252-261-3333
Practice Address - Street 1:5200 N CROATAN HWY
Practice Address - Street 2:SUITES 10 & 11
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3990
Practice Address - Country:US
Practice Address - Phone:252-261-7999
Practice Address - Fax:252-261-3333
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist