Marjorie Karen Graham

Key facts

NPI

1790408243

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

RPH014977 (GA)

Practice address

2055 E Victory Dr
Savannah, GA 31404-3716

Phone

(912) 352-0303

NPI assigned

Sep 20, 2022

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia CVS Pharmacy LLC Pharmacy · Savannah, GA · NPI 1124121876
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 20, 2022.

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1790408243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 COLUMBUS DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054306",
            "telephone_number": "912-429-3216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 E VICTORY DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314043716",
            "telephone_number": "912-352-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "MARJORIE",
        "middle_name": "KAREN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH014977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA BOARD OF PHARMACY",
            "identifier": "RPH014977",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NA",
            "affiliation": "Y",
            "affiliationName": "CVS/Caremark Pharmacy",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2055 E Victory Dr",
            "city": "Savannah",
            "state": "GA",
            "country_code": "US",
            "postal_code": "314043716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Savannah, GA

• C. Thomas Graham, D.M.D.
• Carlos Devone Graham, MSW, LCSW
• Kelly Graham
• Kristen Graham
• Mallory Graham, PHARMD
• Sarah S Graham, CRNA
• Shanika Graham, FNP-BC
• Sonia Graham
• Summer Granado, PMHNP
• Richard Pomeroy Granse, MD

All providers in Savannah, GA · Pharmacist in Georgia