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General NPI Number Information
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NPI Number | 1467650408
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Entity Type | Individual
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Provider Name | SUSAN L GROOM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | RR 2 BOX 46
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City | GRANT CITY
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State | MO
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Zip | 64456-8948
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Country | US
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Telephone | 660-326-2183
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Fax |
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Provider Business Mailing Address
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Address Line | RR 2 BOX 46
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City | GRANT CITY
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State | MO
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Zip | 64456-8948
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Country | US
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Telephone | 660-326-2183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2000164251
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | MO
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