Provider Demographics
NPI:1952561490
Name:GROBER, KELLY ANDREA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANDREA
Last Name:GROBER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 S HARVARD AVE
Mailing Address - Street 2:DRUG WAREHOUSE #7
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4401
Mailing Address - Country:US
Mailing Address - Phone:918-869-1885
Mailing Address - Fax:918-748-0452
Practice Address - Street 1:3126 S HARVARD AVE
Practice Address - Street 2:DRUG WAREHOUSE #7
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4401
Practice Address - Country:US
Practice Address - Phone:918-869-1885
Practice Address - Fax:918-748-0452
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist