Provider Demographics
NPI:1528017647
Name:GRX HOLDINGS LLC
Entity Type:Organization
Organization Name:GRX HOLDINGS LLC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:515-440-1270
Mailing Address - Street 1:1300 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2404
Mailing Address - Country:US
Mailing Address - Phone:515-283-1782
Mailing Address - Fax:515-263-8134
Practice Address - Street 1:1300 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2404
Practice Address - Country:US
Practice Address - Phone:515-283-1782
Practice Address - Fax:515-263-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
IA6923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1616664OtherNCPDP #
IABM2717847OtherDEA #
IABM2717847OtherDEA #
IAIB1186Medicare PIN
IABM2717847OtherDEA #
IAI 10750Medicare PIN