Provider Demographics
NPI:1427004894
Name:GRCY PHARMACIES, LLC
Entity Type:Organization
Organization Name:GRCY PHARMACIES, LLC
Other - Org Name:GELSONS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-906-5721
Mailing Address - Street 1:2707 VIA DE LA VALLE
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1905
Mailing Address - Country:US
Mailing Address - Phone:858-481-4029
Mailing Address - Fax:858-755-3050
Practice Address - Street 1:2707 VIA DE LA VALLE
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1905
Practice Address - Country:US
Practice Address - Phone:858-481-4029
Practice Address - Fax:858-755-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA540763336C0003X
CAPHY513813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155570OtherPK
1998088OtherPK
CA071PHA439350Medicaid
0483391372Medicare NSC