Provider Demographics
NPI:1841589942
Name:GRAHAM, LISA FAYE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:FAYE
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 1:3026 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0243
Mailing Address - Country:US
Mailing Address - Phone:270-684-9261
Mailing Address - Fax:270-684-9678
Practice Address - Street 1:3026 E 4TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0243
Practice Address - Country:US
Practice Address - Phone:270-684-9261
Practice Address - Fax:270-684-9678
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist