# GRUBBS PHARMACY SE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grubb's SE Pharmacy and Mini-mart
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104183342
- **Authorized official:** MICHAEL KIM PHARM.D. (OWNER/VP)
- **Authorized official phone:** (202) 543-4400

## Contact information

- **Practice address:** 1800 MARTIN LUTHER KING JR AVE SE, WASHINGTON, DC 20020-6900
- **Practice address phone:** (202) 503-3610
- **Practice address fax:** (202) 503-2639
- **Mailing address:** 1800 MARTIN LUTHER KING JR AVE SE, WASHINGTON, DC 20020-6900
- **Mailing address phone:** (202) 503-3610
- **Mailing address fax:** (202) 503-2639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RX1200011 | DC | Yes |

## Other

- **Enumeration date:** 04/12/2012
- **Last updated:** 12/05/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2135251 | PK | — |