Provider Demographics
NPI:1891218780
Name:GRAHAM, KATHRYN M (RPH)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:M
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 1:25850 N GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632
Mailing Address - Country:US
Mailing Address - Phone:209-365-0642
Mailing Address - Fax:
Practice Address - Street 1:8364 ROVANA CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-2522
Practice Address - Country:US
Practice Address - Phone:626-739-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist