Cody Wayne Graham | Tyler, TX • PECOS Search

Cody Wayne Graham

Pharmacist

Pharmacy Service Providers

5415 S. Broadway Ave., Tyler, TX 75703

PECOS Enrollment

Based on the most recent information from CMS, provider Cody Wayne Graham does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1427572544
Provider Type
Individual
Full Name
Graham, Cody Wayne
Gender
Male

Sole Proprietor
No
Enumeration Date
7/31/2017
Last Updated
7/31/2017

Contact Information

Practice Location

5415 S. Broadway Ave., Tyler, TX 75703

Unlisted Fax

Mailing Location

5415 S Broadway Ave, Tyler, TX 75703-1397

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 183500000X Primary	Description Pharmacist Pharmacy Service Providers	License 60949 Texas