Provider Demographics
NPI:1366908865
Name:GRAVES, HOLDEN T (PHARMD)
Entity type:Individual
Prefix:
First Name:HOLDEN
Middle Name:T
Last Name:GRAVES
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 1:6608 MANZANO ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7372
Mailing Address - Country:US
Mailing Address - Phone:479-524-7672
Mailing Address - Fax:
Practice Address - Street 1:1340 EMPIRE CENTRAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4022
Practice Address - Country:US
Practice Address - Phone:214-867-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14038183500000X
TX60914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist