Provider Demographics
NPI:1386649028
Name:GRUBBS PHARMACY OF DC INC
Entity Type:Organization
Organization Name:GRUBBS PHARMACY OF DC INC
Other - Org Name:GRUBB'S LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:202-543-4400
Mailing Address - Street 1:326 E CAPITOL ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3809
Mailing Address - Country:US
Mailing Address - Phone:202-543-4400
Mailing Address - Fax:202-547-1314
Practice Address - Street 1:326 E CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3809
Practice Address - Country:US
Practice Address - Phone:202-543-4400
Practice Address - Fax:202-547-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-18
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
DCRX88000773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC020841500Medicaid
MD044562200Medicaid
DC0910090Medicaid
2004422OtherPK
VA8503338Medicaid
DC020841500Medicaid