1922026962 NPI number — GRAHAM SERVICES, INC.

Table of content: (NPI 1922026962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922026962 NPI number — GRAHAM SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAHAM SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922026962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SOUTH SECOND AVE.
Provider Second Line Business Mailing Address:
P.O. DRAWER B
Provider Business Mailing Address City Name:
BALDWYN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38824-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-365-5294
Provider Business Mailing Address Fax Number:
662-365-5295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWYN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38824-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-365-5294
Provider Business Practice Location Address Fax Number:
662-365-5295
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
662-365-5294

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  E-5900 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00330515 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440670 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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