Provider Demographics
NPI:1770527855
Name:GRAHAM, DIGI (DPH)
Entity type:Individual
Prefix:DR
First Name:DIGI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 E 45TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3818
Mailing Address - Country:US
Mailing Address - Phone:918-231-7979
Mailing Address - Fax:
Practice Address - Street 1:10810 E 45TH ST
Practice Address - Street 2:STE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3818
Practice Address - Country:US
Practice Address - Phone:918-231-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist