Provider Demographics
NPI:1265915854
Name:GRAHAM, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FORESIDE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1432
Mailing Address - Country:US
Mailing Address - Phone:207-344-5044
Mailing Address - Fax:
Practice Address - Street 1:335 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3128
Practice Address - Country:US
Practice Address - Phone:207-282-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR69376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist