Provider Demographics
NPI:1487998340
Name:GRAHAM, SHEILA GENARINA (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:GENARINA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:SHEILA
Other - Middle Name:GENARINA
Other - Last Name:BACO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:16 WOODHILL PL
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5965
Mailing Address - Country:US
Mailing Address - Phone:772-323-8329
Mailing Address - Fax:
Practice Address - Street 1:1041 YORK ST
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4025
Practice Address - Country:US
Practice Address - Phone:803-649-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist