Provider Demographics
NPI:1750998894
Name:GRAHAM, KAYSE-ANN
Entity type:Individual
Prefix:
First Name:KAYSE-ANN
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 1:8600 HARRY HINES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-3005
Mailing Address - Country:US
Mailing Address - Phone:888-242-8401
Mailing Address - Fax:844-343-3504
Practice Address - Street 1:8600 HARRY HINES BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-3005
Practice Address - Country:US
Practice Address - Phone:888-242-8401
Practice Address - Fax:844-343-3504
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist