Organization
GRX HOLDINGS LLC
Active
Other names
Medicap Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FULLER (PRESIDENT)
(515) 321-7644
Entity
Organization
Contact information
Practice address
2105 N 3RD LN, INDIANOLA, IA 50125
(515) 961-5303
(515) 961-5964
Mailing address
2105 N 3RD LN, INDIANOLA, IA 50125
(515) 961-5303
(515) 961-5964
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
495
IA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1613606
NCPDP #
IA
Enumeration date
05/08/2006
Last updated
09/11/2025
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