Organization
GRX HOLDINGS LLC
Active
Other names
MEDICAP PHARMACY LTC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FULLER (PRESIDENT)
(515) 321-7644
Entity
Organization
Contact information
Practice address
404 E EUCLID AVE, INDIANOLA, IA 50125-1730
(515) 962-9399
(515) 962-2202
Mailing address
404 E EUCLID AVE, INDIANOLA, IA 50125-1730
(515) 962-9399
(515) 962-2202
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1309
IA
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622871
NCPDP
IA
Enumeration date
11/29/2006
Last updated
12/17/2024
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