Organization
GRX HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FULLER (PRESIDENT)
(515) 321-7644
Entity
Organization
Contact information
Practice address
950 28TH AVE SW, SUITE 1, ALTOONA, IA 50009-3927
(515) 957-0001
(515) 957-0004
Mailing address
950 28TH AVE SW, SUITE 1, ALTOONA, IA 50009
(515) 957-0001
(515) 957-0004
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1130
IA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831409846
—
IA
01
—
2127125
PK
—
Enumeration date
10/12/2010
Last updated
12/17/2024
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