Provider Demographics
NPI:1770525206
Name:GRAHAM PHARMACY INC
Entity type:Organization
Organization Name:GRAHAM PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:620-347-8311
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:ARMA
Mailing Address - State:KS
Mailing Address - Zip Code:66712-0809
Mailing Address - Country:US
Mailing Address - Phone:620-347-8311
Mailing Address - Fax:620-347-8915
Practice Address - Street 1:504 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ARMA
Practice Address - State:KS
Practice Address - Zip Code:66712-4098
Practice Address - Country:US
Practice Address - Phone:620-347-8311
Practice Address - Fax:620-347-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 332B00000X, 333600000X, 3336L0003X
KS2100163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030658OtherPK
KS200354140AMedicaid
MO60696908Medicaid
MO60696908Medicaid