| Doctor Name: | DANIELLE GROOMS |
| NPI Number: | 1124477351 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | TT0011411 |
| Business Practice Address: | 5449 Longview Dr Cross Lanes, WV - 253131514 |
| Business Phone Number: | 3045410366 |
| Business Fax Number: | |
| Mailing Address: | 5449 Longview Dr, CROSS LANES |
| State: | WV |
| Postal Code: | 253131514 |
| Phone Number: | 3045410366 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2016 |
| NPI Last Update Date: | 06/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 183700000X |
| License Number: | TT0011411 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacy Technician |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |