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General NPI Number Information
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NPI Number | 1699337345
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Entity Type | Individual
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Provider Name | GREGORY MATHEW GROOMS
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Gender | Male
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 801 OAKDALE RD STE F
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City | MODESTO
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State | CA
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Zip | 95355-4591
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Country | US
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Telephone | 209-525-9430
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Fax |
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Provider Business Mailing Address
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Address Line | 801 OAKDALE RD STE F
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City | MODESTO
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State | CA
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Zip | 95355-4591
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Country | US
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Telephone |
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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 | 077862
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License Number State | CA
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