Provider Demographics
NPI:1588276331
Name:CROOM, ANDREW TYLER (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:TYLER
Last Name:CROOM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4203
Mailing Address - Country:US
Mailing Address - Phone:252-695-6253
Mailing Address - Fax:252-695-6256
Practice Address - Street 1:3101 E 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4203
Practice Address - Country:US
Practice Address - Phone:252-695-6253
Practice Address - Fax:252-695-6256
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist