Individual
LEROY CLARENCE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH
Contact information
Practice address
125 S WASHINGTON ST, NEVADA, MO 64772-3329
(816) 732-5514
Mailing address
5322 W. 141ST TERR, LEAWOOD, KS 66224-1157
(913) 608-5411
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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