CJ Groetken, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

051290827 Issued in IL

Practice address

100 S Fell Ave
Normal, IL 61761-6627

Phone

(309) 452-0393

NPI assigned

Dec 7, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1962008805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S FELL AVE",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616627",
            "telephone_number": "309-452-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S FELL AVE",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616627",
            "telephone_number": "309-452-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROETKEN",
        "first_name": "CJ",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051290827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Griesbaum Family Chiropractic S C
• Timothy Joseph Griesbaum, D.C.
• Anthony Griffin, CRNA
• Shannon Griffith, B.S.
• Sophia Grimmer
• Jill Groetken
• Elizabeth Gross, ATC
• Anzhelika Grzesiak, APRN, FNP-C
• Gina Nicole Guglielmi, DO
• Yulia Gulay

• Pharmacist in Normal, IL
• Providers in Normal, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.