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Individual
LEROY CLARENCE GRAHAM
Active
Individual
LEROY CLARENCE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
027882
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18350000X
PHARMACIST
MO
Enumeration date
02/22/2012
Last updated
02/22/2012
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