Provider Demographics
NPI:1063875144
Name:GRAHAM APOTHECARY, INC
Entity type:Organization
Organization Name:GRAHAM APOTHECARY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-832-2121
Mailing Address - Street 1:9500 HIGHWAY 805
Mailing Address - Street 2:PO BOX 747
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-8183
Mailing Address - Country:US
Mailing Address - Phone:606-832-2121
Mailing Address - Fax:606-832-2118
Practice Address - Street 1:9500 HIGHWAY 805
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-8183
Practice Address - Country:US
Practice Address - Phone:606-832-2121
Practice Address - Fax:606-832-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies