1003338187 NPI number — DR. PHILIP EDWARD GRAVES PHARM D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003338187 NPI number — DR. PHILIP EDWARD GRAVES PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAVES
Provider First Name:
PHILIP
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1003338187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 E FM 700 APT 418
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIG SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79720-5769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-569-2622
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 S GREGG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79720-5437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-263-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  56990 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com