Individual
TATIANA VASILIEVNA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
901 JOHNSON ST, ELKHART, IN 46514-3329
(574) 264-5996
Mailing address
71210 INDIANA LAKE DR, UNION, MI 49130
(574) 265-9640
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
26023521A
IN
3336C0003X
Community/Retail Pharmacy
Primary
26023521A
IN
Other
Enumeration date
11/19/2019
Last updated
12/21/2022
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