Provider Demographics
NPI:1982977666
Name:GRAHAM, BOBBY JOSEPH JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:JOSEPH
Last Name:GRAHAM
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 FREDERICK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3314
Mailing Address - Country:US
Mailing Address - Phone:757-391-9123
Mailing Address - Fax:757-391-9140
Practice Address - Street 1:700 FREDERICK BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3314
Practice Address - Country:US
Practice Address - Phone:757-391-9123
Practice Address - Fax:757-391-9140
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist