Provider Demographics
NPI:1023111986
Name:GRAHAM, LEONARD ALEX (RPH)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:ALEX
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:W6769 HIGHWAY M-69
Mailing Address - Street 2:
Mailing Address - City:FELCH
Mailing Address - State:MI
Mailing Address - Zip Code:49831
Mailing Address - Country:US
Mailing Address - Phone:906-542-7250
Mailing Address - Fax:
Practice Address - Street 1:325 EAST H STREET
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist