Provider Demographics
NPI:1316052483
Name:GRAHAM, LAURIE SUE (RPH)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:SUE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 EAST WASHINGTON STREET
Mailing Address - Street 2:PO BOX 809
Mailing Address - City:ARMA
Mailing Address - State:KS
Mailing Address - Zip Code:66712-0809
Mailing Address - Country:US
Mailing Address - Phone:620-347-8311
Mailing Address - Fax:620-347-8915
Practice Address - Street 1:504 EAST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ARMA
Practice Address - State:KS
Practice Address - Zip Code:66712-0809
Practice Address - Country:US
Practice Address - Phone:620-347-8311
Practice Address - Fax:620-347-8915
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO606969608Medicaid
KS200354140BMedicaid
KS200354140AMedicaid