Provider Demographics
NPI:1205066982
Name:GRAHAM, RICHARD LEWIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEWIS
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DICK
Other - Middle Name:LEWIS
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:100 FERGUS ST
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:MT
Mailing Address - Zip Code:59471-0014
Mailing Address - Country:US
Mailing Address - Phone:406-464-7571
Mailing Address - Fax:
Practice Address - Street 1:100 FERGUS ST
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:MT
Practice Address - Zip Code:59471-0014
Practice Address - Country:US
Practice Address - Phone:406-464-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1838183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1838OtherMONTANA BOARD OF PHARMACY LICENSE NUMBER