Provider Demographics
NPI:1669786968
Name:GROOMS, JOANNA RUTH
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:RUTH
Last Name:GROOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2903
Mailing Address - Country:US
Mailing Address - Phone:402-296-6256
Mailing Address - Fax:402-296-6262
Practice Address - Street 1:211 S 23RD ST
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2903
Practice Address - Country:US
Practice Address - Phone:402-296-6256
Practice Address - Fax:402-296-6262
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11856183500000X
IA19846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist