Provider Demographics
NPI:1780894196
Name:GRABEN, ROGER DALE (RPH, PHD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DALE
Last Name:GRABEN
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 E MILL RD
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36266-3608
Mailing Address - Country:US
Mailing Address - Phone:256-239-9373
Mailing Address - Fax:256-396-5241
Practice Address - Street 1:438 E MILL RD
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36266-3608
Practice Address - Country:US
Practice Address - Phone:256-239-9373
Practice Address - Fax:256-396-5241
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10883183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy