Provider Demographics
NPI:1871783597
Name:GRAHAM, BRUCE RADCLIFFE (RPH)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:RADCLIFFE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 BARBOUR MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1511
Mailing Address - Country:US
Mailing Address - Phone:502-339-7828
Mailing Address - Fax:
Practice Address - Street 1:7808 BARBOUR MANOR DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1511
Practice Address - Country:US
Practice Address - Phone:502-339-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist