MEDICARE: JOANNA RUTH GROOMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11856	NE
2	183500000X	Pharmacist	19846	IA

General Provider Information

NPI Number	:	1669786968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA RUTH GROOMS

Provider Business Mailing Address
First Line	:	211 S 23RD ST
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2903
Country	:	US
Telephone Number	:	402-296-6256
Fax Number	:	402-296-6262

Provider Business Practice Location Address
First Line	:	211 S 23RD ST
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2903
Country	:	US
Telephone Number	:	402-296-6256
Fax Number	:	402-296-6262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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Directions to “ JOANNA RUTH GROOMS ” Practice Location

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