Provider Demographics
NPI:1376870535
Name:GROOM, PATRICIA KATHLEEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KATHLEEN
Last Name:GROOM
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 1:1600 GUM BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5201
Mailing Address - Country:US
Mailing Address - Phone:910-478-4949
Mailing Address - Fax:910-478-4946
Practice Address - Street 1:1600 GUM BRANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5201
Practice Address - Country:US
Practice Address - Phone:910-478-4949
Practice Address - Fax:910-478-4946
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist