Healthcare Provider Details

I. General information

NPI: 1407948870
Provider Name (Legal Business Name): VICKI LYN GROO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST RM 3C UNIVERSITY OF ILLINOIS OUTPATIENT CARE CENTER
CHICAGO IL
60612
US

IV. Provider business mailing address

833 S WOOD ST RM 164 UNIVERSITY OF ILLINOIS COLLEGE OF PHARMACY
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6480
  • Fax:
Mailing address:
  • Phone: 312-413-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: