Provider Demographics
NPI:1780876417
Name:GROEN, JOHN D (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:GROEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18324 48TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4614
Mailing Address - Country:US
Mailing Address - Phone:206-852-5533
Mailing Address - Fax:425-712-3622
Practice Address - Street 1:18324 48TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4614
Practice Address - Country:US
Practice Address - Phone:206-852-5533
Practice Address - Fax:425-712-3622
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist