Individual
MCKENZIE ANN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD, RPH
Contact information
Practice address
845 N FEDERAL BLVD, RIVERTON, WY 82501
(307) 857-6023
Mailing address
418 W PERSHING AVE APT 4, RIVERTON, WY 82501-2428
(307) 331-8892
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4056
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4056
WYOMING BOARD OF PHARMACY IMMUNIZER LICENSE
WY
Enumeration date
08/21/2018
Last updated
07/13/2020
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