Provider Demographics
NPI:1407651979
Name:GRAHAM, BLAKE (PHARMD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4496 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-3449
Mailing Address - Country:US
Mailing Address - Phone:810-922-9343
Mailing Address - Fax:
Practice Address - Street 1:325 W ATHERTON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2601
Practice Address - Country:US
Practice Address - Phone:855-768-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist