Basic Information
| Provider Information | |||||||||
| NPI: | 1871710608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAFT | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5805 OAK FOREST RD | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730032501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053417719 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 E 9TH ST | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730345705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053418150 | ||||||||
| FaxNumber: | 4053410865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 12674 | OK | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.