Provider Demographics
NPI:1780284521
Name:GRAVES, JAMESHIA DACHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMESHIA
Middle Name:DACHELLE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 BASSFIELD CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:BASSFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39421-8902
Mailing Address - Country:US
Mailing Address - Phone:601-543-2720
Mailing Address - Fax:
Practice Address - Street 1:3310-A HIGHWAY 39 NORTH
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-286-6859
Practice Address - Fax:601-286-6858
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-13973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist