Basic Information
| Provider Information | |||||||||
| NPI: | 1780284521 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAVES | ||||||||
| FirstName: | JAMESHIA | ||||||||
| MiddleName: | DACHELLE | ||||||||
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| Credential: | PHARMD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 469 BASSFIELD CEMETERY RD | ||||||||
| Address2: | |||||||||
| City: | BASSFIELD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394218902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015432720 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3310-A HIGHWAY 39 NORTH | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012866859 | ||||||||
| FaxNumber: | 6012866858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | E-13973 | MS | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.