Provider Demographics
NPI:1679867303
Name:GRAHAM, KATINA BURRIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATINA
Middle Name:BURRIS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 W WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-2891
Mailing Address - Country:US
Mailing Address - Phone:704-825-3958
Mailing Address - Fax:704-825-5692
Practice Address - Street 1:6507 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2891
Practice Address - Country:US
Practice Address - Phone:704-825-3958
Practice Address - Fax:704-825-5692
Is Sole Proprietor?:No
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist