Provider Demographics
NPI:1083913438
Name:GROVES, ANGELA RENEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:GROVES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WINDHAVEN BAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6913
Mailing Address - Country:US
Mailing Address - Phone:615-218-5895
Mailing Address - Fax:
Practice Address - Street 1:614A HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9354
Practice Address - Country:US
Practice Address - Phone:615-581-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000033633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist