Provider Demographics
NPI:1205269511
Name:GRAHAM, DIANE BROWDER
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:BROWDER
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BROWDER
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11399 MEMORIAL PKWY SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2125
Mailing Address - Country:US
Mailing Address - Phone:256-885-2212
Mailing Address - Fax:256-885-2364
Practice Address - Street 1:11399 MEMORIAL PKWY SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2125
Practice Address - Country:US
Practice Address - Phone:256-885-2212
Practice Address - Fax:256-885-2364
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist