Provider Demographics
NPI:1518264555
Name:GRUBBS PHARMACY, LLC
Entity Type:Organization
Organization Name:GRUBBS PHARMACY, LLC
Other - Org Name:GRUBBS PHARMACY & SURGICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:VN
Authorized Official - Last Name:PADMANABHUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-409-8021
Mailing Address - Street 1:2714 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2568
Mailing Address - Country:US
Mailing Address - Phone:302-791-9899
Mailing Address - Fax:302-791-9996
Practice Address - Street 1:2714 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2568
Practice Address - Country:US
Practice Address - Phone:302-791-9899
Practice Address - Fax:302-791-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6523780001Medicare NSC