Provider Demographics
NPI:1700660511
Name:MCBROOM, KATIE ELIZABETH CORMIER (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH CORMIER
Last Name:MCBROOM
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951-0130
Mailing Address - Country:US
Mailing Address - Phone:792-797-6914
Mailing Address - Fax:479-339-8856
Practice Address - Street 1:920 S HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:BONANZA
Practice Address - State:AR
Practice Address - Zip Code:72916-3420
Practice Address - Country:US
Practice Address - Phone:479-279-7691
Practice Address - Fax:479-339-8856
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist