Healthcare Provider Details

I. General information

NPI: 1083680169
Provider Name (Legal Business Name): CHRISTENA HOPE GROOMS C.PH.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BAKER HWY SUITE #1
HUNTSVILLE TN
37756-4168
US

IV. Provider business mailing address

2055 HELENWOOD LOOP RD
HELENWOOD TN
37755-5509
US

V. Phone/Fax

Practice location:
  • Phone: 423-663-9355
  • Fax: 423-663-3992
Mailing address:
  • Phone: 423-569-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number17932
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: