Provider Demographics
NPI:1215133236
Name:GRAHAM, NOELLE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2316
Mailing Address - Country:US
Mailing Address - Phone:508-791-3955
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:ATTN: PRESCRIPTON CENTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-421-1900
Practice Address - Fax:508-334-2264
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist