Provider Demographics
NPI:1124057500
Name:GRAHAM, ERIC M
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N GRAND ST
Mailing Address - Street 2:
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087-5110
Mailing Address - Country:US
Mailing Address - Phone:269-679-2000
Mailing Address - Fax:269-679-3564
Practice Address - Street 1:311 N GRAND ST
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-5110
Practice Address - Country:US
Practice Address - Phone:269-679-2000
Practice Address - Fax:269-679-3564
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist