Provider Demographics
NPI:1912237173
Name:DEGROOTE, DAVID R (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:DEGROOTE
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 1:16749 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6602
Mailing Address - Country:US
Mailing Address - Phone:480-837-5889
Mailing Address - Fax:480-837-7504
Practice Address - Street 1:16749 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6602
Practice Address - Country:US
Practice Address - Phone:480-837-5889
Practice Address - Fax:480-837-7504
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist