# GRANE SUPPLY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elwyn Rx at Fair Acres
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255705349
- **Authorized official:** MR. ROBERT CHARLES FUNDERLICH (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (412) 449-0690

## Contact information

- **Practice address:** 340 N MIDDLETOWN RD, LIMA, PA 19063
- **Practice address phone:** (610) 891-5783
- **Practice address fax:** (610) 891-5860
- **Mailing address:** 105 GAMMA DRIVE, SUITE 100, PITTSBURGH, PA 15238
- **Mailing address phone:** (412) 449-0680
- **Mailing address fax:** (129) 685-8004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PP482618 | PA | Yes |

## Other

- **Enumeration date:** 11/30/2015
- **Last updated:** 07/27/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1008270470004 | — | PA |
| 01 | — | PP482618 | BOARD OF PHARMACY | PA |