Provider Demographics
NPI:1952999328
Name:GRAHAM, COURTNEY TRAINER (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TRAINER
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MOORE
Other - Last Name:TRAINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5919
Mailing Address - Country:US
Mailing Address - Phone:802-654-0772
Mailing Address - Fax:
Practice Address - Street 1:69 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5919
Practice Address - Country:US
Practice Address - Phone:802-654-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0103682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist