Provider Demographics
NPI:1023044179
Name:GRX HOLDINGS LLC
Entity Type:Organization
Organization Name:GRX HOLDINGS LLC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-440-1270
Mailing Address - Street 1:10 S WARRIOR LANE
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9593
Mailing Address - Country:US
Mailing Address - Phone:515-987-8111
Mailing Address - Fax:515-987-8128
Practice Address - Street 1:10 S WARRIOR LANE
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-5026
Practice Address - Country:US
Practice Address - Phone:515-987-8111
Practice Address - Fax:515-987-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA332B00000X
IA11033336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1620194OtherNCPDP #
IA1620194OtherNCPDP #
IA1620194OtherNCPDP #
IA6111740001Medicare NSC
IA6111740001Medicare NSC
IA0490235Medicaid
IAIB1192Medicare PIN