Provider Demographics
NPI:1295464162
Name:GROENKE, GEOFFREY
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:GROENKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1509
Mailing Address - Country:US
Mailing Address - Phone:330-575-4787
Mailing Address - Fax:
Practice Address - Street 1:1700 NICHOLASVILLE RD STE 1210
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1464
Practice Address - Country:US
Practice Address - Phone:859-639-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist