Healthcare Provider Details

I. General information

NPI: 1720976970
Provider Name (Legal Business Name): KYLE ROBERT GROOMS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-2402
US

IV. Provider business mailing address

7000 CAMELBACK DR NE
ROCKFORD MI
49341-9684
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-1221
  • Fax: 616-365-9996
Mailing address:
  • Phone: 616-884-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302417606
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: