Individual
MATTHEW ROBERT GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
11124 HOLMES RD, KANSAS CITY, MO 64131-3625
(816) 942-3262
(816) 942-7660
Mailing address
1808 SW MERRYMAN DR, LEES SUMMIT, MO 64082-3912
(816) 536-0595
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2019025929
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019025929
MISSOURI BOARD OF PHARMACY LICENSE NUMBER
MO
Enumeration date
11/30/2020
Last updated
11/30/2020
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