Provider Demographics
NPI:1487995098
Name:GRAHAM, NANCY ELLEN (RPH)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELLEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:ELLEN
Other - Last Name:KUECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1000 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4810
Mailing Address - Country:US
Mailing Address - Phone:512-459-8308
Mailing Address - Fax:
Practice Address - Street 1:1000 E 41ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4810
Practice Address - Country:US
Practice Address - Phone:512-459-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist