Provider Demographics
NPI:1063839496
Name:G & G RX INC
Entity Type:Organization
Organization Name:G & G RX INC
Other - Org Name:G & G PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-774-8701
Mailing Address - Street 1:1500 14TH ST W
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801
Mailing Address - Country:US
Mailing Address - Phone:701-572-7979
Mailing Address - Fax:
Practice Address - Street 1:1500 14TH STREET WEST
Practice Address - Street 2:SUITE 150
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5303
Practice Address - Country:US
Practice Address - Phone:701-572-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPHAR3833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy