Provider Demographics
NPI:1629469531
Name:MACBROOM, CATHERINE (RPH)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MACBROOM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BARNWELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3937
Mailing Address - Country:US
Mailing Address - Phone:803-643-4403
Mailing Address - Fax:803-644-4405
Practice Address - Street 1:415 BARNWELL AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3937
Practice Address - Country:US
Practice Address - Phone:803-643-4403
Practice Address - Fax:803-644-4405
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist