Provider Demographics
NPI:1629351416
Name:GROTA, CASEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GROTA
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 1:2117 WOOD DUCK WAY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2703
Mailing Address - Country:US
Mailing Address - Phone:573-620-6096
Mailing Address - Fax:
Practice Address - Street 1:2117 WOOD DUCK WAY
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-2703
Practice Address - Country:US
Practice Address - Phone:157-362-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010034685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist