Provider Demographics
NPI:1114068921
Name:GRX HOLDINGS, LLC
Entity Type:Organization
Organization Name:GRX HOLDINGS, LLC
Other - Org Name:MEDICAP LTC VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-440-1270
Mailing Address - Street 1:404 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-1730
Mailing Address - Country:US
Mailing Address - Phone:515-962-2656
Mailing Address - Fax:515-962-2202
Practice Address - Street 1:404 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1730
Practice Address - Country:US
Practice Address - Phone:515-962-2656
Practice Address - Fax:515-962-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13093336H0001X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1622871OtherNCPDP
IAFM0075932OtherDEA
1622871OtherNCPDP
IAFM0075932OtherDEA