Provider Demographics
NPI:1073764973
Name:GRIPKA PHARMACY LLC
Entity Type:Organization
Organization Name:GRIPKA PHARMACY LLC
Other - Org Name:THE MEDICINE STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIPKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:913-724-3666
Mailing Address - Street 1:15415 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-8237
Mailing Address - Country:US
Mailing Address - Phone:913-724-3666
Mailing Address - Fax:913-724-3667
Practice Address - Street 1:15415 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-8237
Practice Address - Country:US
Practice Address - Phone:913-724-3666
Practice Address - Fax:913-724-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
KS2-104033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200879480AMedicaid
2136127OtherPK