Provider Demographics
NPI:1457951550
Name:GRAHAM, DINA C (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:C
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1551
Mailing Address - Country:US
Mailing Address - Phone:864-455-9280
Mailing Address - Fax:864-455-9296
Practice Address - Street 1:807 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1551
Practice Address - Country:US
Practice Address - Phone:864-455-9280
Practice Address - Fax:864-455-9296
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist