Provider Demographics
NPI:1861692691
Name:GRAHAM, DAVID SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 GIBSON BLVD SE
Mailing Address - Street 2:ATTN: PHARMACY ADMINISTRATION
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4729
Mailing Address - Country:US
Mailing Address - Phone:505-262-3973
Mailing Address - Fax:505-262-7842
Practice Address - Street 1:5400 GIBSON BLVD SE
Practice Address - Street 2:ATTN: PHARMACY ADMINISTRATION
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4729
Practice Address - Country:US
Practice Address - Phone:505-262-3973
Practice Address - Fax:505-262-7842
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP6846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist