Provider Demographics
NPI:1306461751
Name:GRAHAM, MARK EDWARD (BS PHARM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-8520
Mailing Address - Country:US
Mailing Address - Phone:717-713-4541
Mailing Address - Fax:
Practice Address - Street 1:5040 RITTER RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4879
Practice Address - Country:US
Practice Address - Phone:888-907-0090
Practice Address - Fax:888-907-0040
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26247183500000X
KY020421183500000X
TN0000042978183500000X
PARP037418L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist