Provider Demographics
NPI:1093765315
Name:GRANDVIEW PHARMACY 11
Entity Type:Organization
Organization Name:GRANDVIEW PHARMACY 11
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-827-0847
Mailing Address - Street 1:2230 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2903
Mailing Address - Country:US
Mailing Address - Phone:765-827-0847
Mailing Address - Fax:765-827-7503
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-1239
Practice Address - Country:US
Practice Address - Phone:765-478-9978
Practice Address - Fax:765-478-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005826A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy