Provider Demographics
NPI:1619100211
Name:GRAVES, ADAM THOMAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:THOMAS
Last Name:GRAVES
Suffix:
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 1:2327 37TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2890
Mailing Address - Country:US
Mailing Address - Phone:505-670-8582
Mailing Address - Fax:
Practice Address - Street 1:1115 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2802
Practice Address - Country:US
Practice Address - Phone:505-753-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist