Provider Demographics
NPI:1093490336
Name:GRUPENHOFF, MARCY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:L
Last Name:GRUPENHOFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 E DISCOVERY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9059
Mailing Address - Country:US
Mailing Address - Phone:812-353-3499
Mailing Address - Fax:812-918-5899
Practice Address - Street 1:2651 E DISCOVERY PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-353-3499
Practice Address - Fax:812-918-5899
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020026A1835C0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0206XPharmacy Service ProvidersPharmacistCardiology