Healthcare Provider Details

I. General information

NPI: 1083541189
Provider Name (Legal Business Name): SEAN MCGROUARY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 FORT JESSE RD
NORMAL IL
61761-3489
US

IV. Provider business mailing address

1508 HANCOCK DR APT 6
NORMAL IL
61761-6734
US

V. Phone/Fax

Practice location:
  • Phone: 309-452-1370
  • Fax:
Mailing address:
  • Phone: 224-540-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.307582
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: