Provider Demographics
NPI:1417694506
Name:GRAHAM, ZEBULON C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ZEBULON
Middle Name:C
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 1:1846 1ST ST STE 389
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4415
Mailing Address - Country:US
Mailing Address - Phone:208-595-2430
Mailing Address - Fax:208-216-0230
Practice Address - Street 1:1846 1ST ST STE 389
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4415
Practice Address - Country:US
Practice Address - Phone:208-595-2430
Practice Address - Fax:208-216-0230
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4543183500000X
IDP10481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1368744OtherNABP