Provider Demographics
NPI:1326363987
Name:GROTON, CLINT D (BS PHARMACY)
Entity Type:Individual
Prefix:MS
First Name:CLINT
Middle Name:D
Last Name:GROTON
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 N BROADWAY
Mailing Address - Street 2:STE 101
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1000
Mailing Address - Country:US
Mailing Address - Phone:914-366-1400
Mailing Address - Fax:914-366-1408
Practice Address - Street 1:777 N BROADWAY
Practice Address - Street 2:STE 101
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1000
Practice Address - Country:US
Practice Address - Phone:914-366-1400
Practice Address - Fax:914-366-1408
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037140-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist