Provider Demographics
NPI:1104116953
Name:GRAHAM, WILL H (PHARMD)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:H
Last Name:GRAHAM
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 1:398 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3401
Mailing Address - Country:US
Mailing Address - Phone:601-853-9607
Mailing Address - Fax:601-898-9148
Practice Address - Street 1:398 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3401
Practice Address - Country:US
Practice Address - Phone:601-853-9607
Practice Address - Fax:601-898-9148
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010259183500000X
FLPS44222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist