Provider Demographics
NPI:1154605830
Name:GROTBECK, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GROTBECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2927
Mailing Address - Country:US
Mailing Address - Phone:785-271-9981
Mailing Address - Fax:785-271-2165
Practice Address - Street 1:2915 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2927
Practice Address - Country:US
Practice Address - Phone:785-271-9981
Practice Address - Fax:785-271-2165
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11763183500000X
WI11711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist