Provider Demographics
NPI:1881020337
Name:GROOMS, MAGGIE M (PHARMD, RPH)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:M
Last Name:GROOMS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 CY AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3561
Mailing Address - Country:US
Mailing Address - Phone:307-266-0156
Mailing Address - Fax:307-266-4982
Practice Address - Street 1:1076 CY AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3561
Practice Address - Country:US
Practice Address - Phone:307-266-0156
Practice Address - Fax:307-266-4982
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist